Provider Demographics
NPI:1922320977
Name:PATRICK S DEPIPPO,MD,PC
Entity Type:Organization
Organization Name:PATRICK S DEPIPPO,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-365-5333
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-0404
Mailing Address - Country:US
Mailing Address - Phone:516-365-5333
Mailing Address - Fax:516-365-3279
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:#401
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3048
Practice Address - Country:US
Practice Address - Phone:516-365-5333
Practice Address - Fax:516-365-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50L341Medicare PIN