Provider Demographics
NPI:1750645040
Name:PIPARO, JEANNIE C (PA)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:C
Last Name:PIPARO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:C
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1 WEST AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6045
Practice Address - Country:US
Practice Address - Phone:518-584-5330
Practice Address - Fax:518-583-7663
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03475129Medicaid
NYJ400075945Medicare PIN