Individual provider · NPI-1

Joseph Richard Ippolito, MD

Family Medicine · Mineola, NY

NPI number1811056161
StatusActive
Last updated in NPPESSep 11, 2025

Details

NPI
1811056161
Entity type
Individual (NPI-1)
Name
Joseph Richard Ippolito
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Dec 6, 2006
Last updated
Sep 11, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineA166931NYYes
207QA0401X Family Medicine, Addiction MedicineA166931NY

Practice location

110 Main St
Mineola, NY 11501-4014

Phone 516-747-5644

Mailing address

523 Hempstead Avenue
Rockville Centre, NY 11570-1752

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