Healthcare Provider Details

I. General information

NPI: 1184528010
Provider Name (Legal Business Name): MPM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WYOMING AVE LOWR LEVEL
KINGSTON PA
18704-9801
US

IV. Provider business mailing address

601 WYOMING AVE LOWR LEVEL
KINGSTON PA
18704-9801
US

V. Phone/Fax

Practice location:
  • Phone: 631-223-6713
  • Fax:
Mailing address:
  • Phone: 631-223-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY CIPOLETTI
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 631-223-6713