Provider Demographics
NPI:1437219045
Name:DIPAOLO, PETER F (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:DIPAOLO
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 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2540
Mailing Address - Country:US
Mailing Address - Phone:973-638-1661
Mailing Address - Fax:973-638-1662
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2540
Practice Address - Country:US
Practice Address - Phone:973-638-1661
Practice Address - Fax:973-638-1662
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60375207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7699506Medicaid
NJ7699506Medicaid
NJ011702Medicare PIN
NJG74321Medicare UPIN