Provider Demographics
NPI:1770879249
Name:PETER F. DIPAOLO, MD, PA
Entity type:Organization
Organization Name:PETER F. DIPAOLO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:KOUTOUZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-638-1661
Mailing Address - Street 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2540
Mailing Address - Country:US
Mailing Address - Phone:973-638-1661
Mailing Address - Fax:973-638-1662
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2540
Practice Address - Country:US
Practice Address - Phone:973-638-1661
Practice Address - Fax:973-638-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011702Medicare PIN