Provider Demographics
NPI:1720170269
Name:SIPPERLY, STEPHEN F (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:SIPPERLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:100 GREAT OAKS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-7924
Practice Address - Country:US
Practice Address - Phone:518-869-8007
Practice Address - Fax:518-869-8742
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY187608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01267OtherMVP
NY000401494002OtherBSNENY
NY01563166Medicaid
NY10001909OtherCDPHP
NY200257OtherSENIOR WHOLE HEALTH
NY4402478OtherAETNA
NY692051OtherEMPIRE BC
NY070302000076OtherFIDELIS
NY47356OtherGHI/HMO
NYJ400093109Medicare PIN
NY01267OtherMVP
NY070302000076OtherFIDELIS