Provider Demographics
NPI:1346228525
Name:EPPOLITO, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:EPPOLITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:2949 STATE ROUTE 370
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-9794
Practice Address - Country:US
Practice Address - Phone:315-626-2117
Practice Address - Fax:315-626-2747
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY150410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00819810Medicaid
NY00819810Medicaid
NY080087763Medicare PIN
NYB82447Medicare UPIN