Provider Demographics
NPI:1245230184
Name:CHIEPPA, WAYNE A (DPM)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:A
Last Name:CHIEPPA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1345
Mailing Address - Country:US
Mailing Address - Phone:973-927-2525
Mailing Address - Fax:973-927-3249
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:SUITE 405
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-927-2525
Practice Address - Fax:973-927-3249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00186600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001393891OtherPA HIGHMARK BLUE SHIELD
NJ470036YA8JOtherMEDICARE
NJT87615Medicare UPIN