Provider Demographics
NPI:1225683121
Name:IPPOLITO, DEANNA KORCHA
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:KORCHA
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:K
Other - Last Name:IPPOLITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 COLONY CT
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 COLONY CT
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3204
Practice Address - Country:US
Practice Address - Phone:908-256-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003625152W00000X
WI3689-35152W00000X
NJ005521152W00000X
IL046011466152W00000X
FLTPOP32152W00000X
NE1525152W00000X
MDTA2728152W00000X
VA0618002862152W00000X
CT3221152W00000X
NJ27OA00552100152W00000X
VT030.0133916152W00000X
NY005663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist