Provider Demographics
NPI:1831914191
Name:PIPPEN HEALTH OF NEW JERSEY, P.A
Entity type:Organization
Organization Name:PIPPEN HEALTH OF NEW JERSEY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-270-0190
Mailing Address - Street 1:1023 SPRINGDALE RD # 13A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2465
Mailing Address - Country:US
Mailing Address - Phone:512-270-0190
Mailing Address - Fax:
Practice Address - Street 1:100 CHARLES EWING BLVD STE 160
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3456
Practice Address - Country:US
Practice Address - Phone:512-270-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty