Healthcare Provider Details

I. General information

NPI: 1700072386
Provider Name (Legal Business Name): COLETTE DIPIERRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SAINT ANDREWS PL
MANALAPAN NJ
07726-9541
US

IV. Provider business mailing address

111 W WATER ST PO BOX 4979
TOMS RIVER NJ
08753-6407
US

V. Phone/Fax

Practice location:
  • Phone: 732-275-7975
  • Fax:
Mailing address:
  • Phone: 732-244-4703
  • Fax: 732-244-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00131700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: