Provider Demographics
NPI:1063417327
Name:CIPOLLA, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CIPOLLA
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 1:1486 DEER PARK AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1214
Mailing Address - Country:US
Mailing Address - Phone:631-422-3200
Mailing Address - Fax:631-422-6597
Practice Address - Street 1:1486 DEER PARK AVE UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1214
Practice Address - Country:US
Practice Address - Phone:631-422-3200
Practice Address - Fax:631-422-6597
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0435421OtherCIGNA
NY0976486000OtherAMERIHEALTH ID #
NYCIM175335OtherNF/WC
NYP62369454OtherMULTIPLAN
NY175335OtherLICENSE #
NY01572247Medicaid
NY2505064OtherGHI
NY010175331NY01OtherANTHEM HEALTH ID#
NY045244OtherAETNA/US HEALTHCARE
NY4331591OtherAETNA ID
NY110227279OtherRAILROAD MEDICARE
NY1143305OtherUNITED HEALTHCARE
NY3C3154OtherHEALTHNET
NY08G261OtherBLUE CROSS BLUE SHIELD ID
NY41397OtherVYTRA
NYCP542OtherOXFORD
NYCIM175335OtherNF/WC
NY01572247Medicaid