Provider Demographics
NPI:1407896798
Name:FILIPPONI, RAYMOND (DPM)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:FILIPPONI
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 1:441 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GIBBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08027-1354
Mailing Address - Country:US
Mailing Address - Phone:856-423-7770
Mailing Address - Fax:856-224-1512
Practice Address - Street 1:401 HARMONY RD
Practice Address - Street 2:SUITE 25
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-1723
Practice Address - Country:US
Practice Address - Phone:856-423-7770
Practice Address - Fax:856-224-1512
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01447213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4524608Medicaid
NJMD01447OtherLISCENSE
NJ4524608Medicaid
NJ5950510001Medicare NSC
NJMD01447OtherLISCENSE
NJU26654Medicare UPIN
NJ112032Medicare PIN