Provider Demographics
NPI:1760766174
Name:A CIPOLLA MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:A CIPOLLA MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIPOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-3200
Mailing Address - Street 1:1350 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1619
Mailing Address - Country:US
Mailing Address - Phone:631-422-3200
Mailing Address - Fax:631-422-6597
Practice Address - Street 1:1350 DEER PARK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1619
Practice Address - Country:US
Practice Address - Phone:631-422-3200
Practice Address - Fax:631-422-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty