Provider Demographics
NPI:1679381339
Name:RISPOLI, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RISPOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IN-SOO
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:335 VISTA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2721
Mailing Address - Country:US
Mailing Address - Phone:201-560-7440
Mailing Address - Fax:
Practice Address - Street 1:4216 162ND ST APT 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4155
Practice Address - Country:US
Practice Address - Phone:718-366-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program