Provider Demographics
NPI:1437189735
Name:FILIPPONE, NICHOLAS D (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:FILIPPONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-773-5687
Mailing Address - Fax:518-773-5620
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:MAB SUITE 107
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-773-5687
Practice Address - Fax:518-773-5620
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132035208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01170658Medicaid
NY000915069003OtherBSH NE NY
NY10060753OtherCDPHP
NY4124751OtherMVP HEALTHPLAN
NY01170658Medicaid
NYRA2017Medicare PIN