Provider Demographics
NPI:1710085493
Name:IPPOLITO, ANGELO PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:PETER
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 1:4712 VERNON BLVD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5492
Mailing Address - Country:US
Mailing Address - Phone:718-707-3500
Mailing Address - Fax:718-707-3210
Practice Address - Street 1:4712 VERNON BLVD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5492
Practice Address - Country:US
Practice Address - Phone:718-707-3500
Practice Address - Fax:718-707-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006947-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor