Provider Demographics
NPI:1033166798
Name:DESPLAT, PHILIPPE (DO)
Entity type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:
Last Name:DESPLAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3697
Mailing Address - Country:US
Mailing Address - Phone:201-387-7055
Mailing Address - Fax:201-387-8605
Practice Address - Street 1:40 WASHINGTON AVE
Practice Address - Street 2:VALLEY HEALTH MEDICAL GROUP
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3697
Practice Address - Country:US
Practice Address - Phone:201-387-7055
Practice Address - Fax:201-387-8605
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB04078200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ199389WC0Medicare PIN
NJ199389DRRMedicare PIN