Provider Demographics
NPI:1588930325
Name:ELIO J IPPOLITO MD
Entity type:Organization
Organization Name:ELIO J IPPOLITO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-332-1533
Mailing Address - Street 1:200 S BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-332-1533
Mailing Address - Fax:914-332-1556
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-332-1533
Practice Address - Fax:914-332-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086623261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170181Medicare UPIN
NY0599G1Medicare UPIN