Provider Demographics
NPI:1548216690
Name:KIPEL, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KIPEL
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 1:155 POLIFLY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1758
Mailing Address - Country:US
Mailing Address - Phone:201-487-7617
Mailing Address - Fax:201-342-5341
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:201-487-7617
Practice Address - Fax:201-342-5341
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA051453002080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5593107Medicaid
NJF65170Medicare UPIN
NJ56J723Medicare ID - Type Unspecified