Provider Demographics
NPI:1952009615
Name:SIMPLIFED IPA LLC
Entity Type:Organization
Organization Name:SIMPLIFED IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:339-234-0164
Mailing Address - Street 1:314 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4318
Mailing Address - Country:US
Mailing Address - Phone:844-799-0538
Mailing Address - Fax:631-201-7097
Practice Address - Street 1:314 E STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4318
Practice Address - Country:US
Practice Address - Phone:844-799-0538
Practice Address - Fax:631-201-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty