MEDICARE: MR. WILLIAM IPPOLITO PA-C

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	363A00000X	Physician Assistant	25MP00072000	NJ
2	363AM0700X	Medical Physician Assistant	25MP00072000	NJ

General Provider Information

NPI Number	:	1396723011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM IPPOLITO PA-C

Provider Business Mailing Address
First Line	:	10 PARSONAGE RD 102
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08837-2429
Country	:	US
Telephone Number	:	732-662-4680
Fax Number	:	732-662-3354

Provider Business Practice Location Address
First Line	:	1825 RTE 35
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-3541
Country	:	US
Telephone Number	:	732-280-2600
Fax Number	:

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/01/2022

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