Provider Demographics
NPI:1699827204
Name:ZIPF, GREGORY
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:ZIPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W WASHINGTON AVE
Mailing Address - Street 2:PO BOX 269
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1916
Mailing Address - Country:US
Mailing Address - Phone:908-689-0240
Mailing Address - Fax:908-689-0676
Practice Address - Street 1:15 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1916
Practice Address - Country:US
Practice Address - Phone:908-689-0240
Practice Address - Fax:908-689-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU23825Medicare UPIN
NJ504361Medicare ID - Type Unspecified