MEDICARE: DR. GREGORIO LIPAT M.D.

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	207RN0300X	Nephrology Physician	25MA02867500	NJ

General Provider Information

NPI Number	:	1790783850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORIO LIPAT M.D.

Provider Business Mailing Address
First Line	:	1 HAMILTON DR E
Second Line	:
City	:	NORTH CALDWELL
State	:	NJ
Zip	:	07006-4602
Country	:	US
Telephone Number	:	201-200-9984
Fax Number	:	201-451-2863

Provider Business Practice Location Address
First Line	:	107 PACIFIC AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-3217
Country	:	US
Telephone Number	:	201-200-9984
Fax Number	:	201-451-2863

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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