Provider Demographics
NPI:1639192172
Name:IPPOLITO, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:IPPOLITO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3004
Mailing Address - Country:US
Mailing Address - Phone:631-669-6221
Mailing Address - Fax:631-669-6007
Practice Address - Street 1:382 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3004
Practice Address - Country:US
Practice Address - Phone:631-669-6221
Practice Address - Fax:631-669-6007
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007683-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3370876OtherTRIAD OXFORD
NYU88155Medicare UPIN
NYX4P021Medicare ID - Type Unspecified