Healthcare Provider Details

I. General information

NPI: 1215097985
Provider Name (Legal Business Name): JAMES CIPOLLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVENUE AT 16TH ST
NEW YORK NY
10003
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2385
  • Fax: 212-420-2364
Mailing address:
  • Phone: 631-264-2035
  • Fax: 631-264-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number191416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: