=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295861045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK STEVEN DEPIPPO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 NORTHERN BLVD STE 126
-----------------------------------------------------
City | GREENVALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11548-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-365-5333
-----------------------------------------------------
Fax | 516-365-3279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 404
-----------------------------------------------------
City | MANHASSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11030-0404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-365-5333
-----------------------------------------------------
Fax | 516-365-3279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 199525
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 199525
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------