Provider Demographics
NPI:1275576910
Name:KRIPSAK, JOHN P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:KRIPSAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 US HIGHWAY 202/206 NORTH, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1704
Mailing Address - Country:US
Mailing Address - Phone:908-722-0808
Mailing Address - Fax:908-722-3415
Practice Address - Street 1:766 US HIGHWAY 202/206 NORTH, SUITE 1
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1704
Practice Address - Country:US
Practice Address - Phone:908-722-0808
Practice Address - Fax:908-722-3415
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05436000207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1331701Medicaid
NJ1331701Medicaid
NJE39954Medicare UPIN
NJ1331701Medicaid
NJ507186A3MMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
NJTP063OtherOXFORD PROVIDER #
NJ0K8653OtherHEALTHNET PROVIDER #