Healthcare Provider Details

I. General information

NPI: 1952009615
Provider Name (Legal Business Name): SIMPLIFED IPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E STATE ST
ITHACA NY
14850-4318
US

IV. Provider business mailing address

314 E STATE ST
ITHACA NY
14850-4318
US

V. Phone/Fax

Practice location:
  • Phone: 844-799-0538
  • Fax: 631-201-7097
Mailing address:
  • Phone: 844-799-0538
  • Fax: 631-201-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA IPPOLITO
Title or Position: CEO
Credential:
Phone: 339-234-0164