Provider Demographics
NPI:1285604041
Name:DIPAOLO, ANN M (DO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:DIPAOLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 LACEY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1051
Mailing Address - Country:US
Mailing Address - Phone:609-693-0819
Mailing Address - Fax:732-349-7842
Practice Address - Street 1:1044 LACEY RD STE 9
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1051
Practice Address - Country:US
Practice Address - Phone:732-349-8866
Practice Address - Fax:732-349-7842
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07677400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0052680Medicaid
NJI19392Medicare UPIN