Healthcare Provider Details

I. General information

NPI: 1447779855
Provider Name (Legal Business Name): GARRY HYPPOLITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 LIBERTY LN STE 210
ALLENTOWN PA
18106-9063
US

IV. Provider business mailing address

4949 LIBERTY LN STE 210
ALLENTOWN PA
18106-9063
US

V. Phone/Fax

Practice location:
  • Phone: 610-966-2676
  • Fax:
Mailing address:
  • Phone: 610-966-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberPN294796
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: