Provider Demographics
NPI:1699963462
Name:CIPPARONE, NICHOLAS ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:CIPPARONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SECOND ST
Mailing Address - Street 2:STE E
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:856-241-2222
Mailing Address - Fax:856-241-7961
Practice Address - Street 1:502-503 INDEPENDENCE BLVD
Practice Address - Street 2:LAKESIDE BUSINESS PARK
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-629-8777
Practice Address - Fax:856-629-8771
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMPT40QA01092600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist