Provider Demographics
NPI:1912973959
Name:CIPOLLARO, VINCENT A (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:CIPOLLARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:10-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:212-588-1963
Mailing Address - Fax:212-753-8229
Practice Address - Street 1:121 E 60TH ST
Practice Address - Street 2:10-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1117
Practice Address - Country:US
Practice Address - Phone:212-588-1963
Practice Address - Fax:212-753-8229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY84708207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00128203Medicaid
NYB08773Medicare UPIN
NYWEY721Medicare ID - Type Unspecified