Healthcare Provider Details

I. General information

NPI: 1457440745
Provider Name (Legal Business Name): CLAUDINE KIPP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-1021
  • Fax:
Mailing address:
  • Phone: 718-920-2961
  • Fax: 718-920-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: