Provider Demographics
NPI:1881930873
Name:SIPZNER, JONATHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:SIPZNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 W PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3213
Mailing Address - Country:US
Mailing Address - Phone:201-880-7480
Mailing Address - Fax:201-880-7487
Practice Address - Street 1:625 MAIN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4952
Practice Address - Country:US
Practice Address - Phone:973-574-1000
Practice Address - Fax:973-574-1001
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025214001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0391531Medicaid