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General NPI Number Information
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NPI Number | 1831914191
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Entity Type | Organization
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Legal Business Name | PIPPEN HEALTH OF NEW JERSEY, P.A
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 100 CHARLES EWING BLVD STE 160
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City | EWING
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State | NJ
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Zip | 08628-3456
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Country | US
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Telephone | 512-270-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 SPRINGDALE RD # 13A
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City | AUSTIN
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State | TX
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Zip | 78721-2465
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Country | US
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Telephone | 512-270-0190
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JON LARSON
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Credential | MD
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Telephone | 512-270-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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