Individual
DANIEL THOMAS IPPOLITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
77 MEDFORD AVE, PATCHOGUE, NY 11772-1281
(631) 666-3951
(631) 750-1177
Mailing address
712 MAIN ST, ISLIP, NY 11751-3620
(631) 666-3951
(631) 750-1177
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308385
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
308385
NYS OFFICE OF PROFESSIONS
NY
Enumeration date
08/10/2017
Last updated
08/10/2017
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