Provider Demographics
NPI:1649495649
Name:OTTAVIO G NEPA
Entity type:Organization
Organization Name:OTTAVIO G NEPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTAVIO
Authorized Official - Middle Name:GIOVANNI
Authorized Official - Last Name:NEPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-237-1640
Mailing Address - Street 1:999 MCBRIDE AVE
Mailing Address - Street 2:SUITE B209
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2570
Mailing Address - Country:US
Mailing Address - Phone:973-237-1640
Mailing Address - Fax:973-237-0265
Practice Address - Street 1:999 MCBRIDE AVE
Practice Address - Street 2:SUITE B209
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2570
Practice Address - Country:US
Practice Address - Phone:973-237-1640
Practice Address - Fax:973-237-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
814635Medicare PIN
U59257Medicare UPIN