MEDICARE: DR. ANTHONY CIPOLLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	175335	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	110227279	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0435421	OTHER	NY	CIGNA
2	0976486000	OTHER	NY	AMERIHEALTH ID #
3	CIM175335	OTHER	NY	NF/WC
4	P62369454	OTHER	NY	MULTIPLAN
5	175335	OTHER	NY	LICENSE #
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2505064	OTHER	NY	GHI
8	010175331NY01	OTHER	NY	ANTHEM HEALTH ID#
9	045244	OTHER	NY	AETNA/US HEALTHCARE
10	4331591	OTHER	NY	AETNA ID
12	1143305	OTHER	NY	UNITED HEALTHCARE
13	3C3154	OTHER	NY	HEALTHNET
14	08G261	OTHER	NY	BLUE CROSS BLUE SHIELD ID
15	41397	OTHER	NY	VYTRA
16	CP542	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1063417327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY CIPOLLA MD

Provider Business Mailing Address
First Line	:	1486 DEER PARK AVE UNIT A
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-1214
Country	:	US
Telephone Number	:	631-422-3200
Fax Number	:	631-422-6597

Provider Business Practice Location Address
First Line	:	1486 DEER PARK AVE UNIT A
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-1214
Country	:	US
Telephone Number	:	631-422-3200
Fax Number	:	631-422-6597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/09/2021

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