Healthcare Provider Details

I. General information

NPI: 1588635817
Provider Name (Legal Business Name): KENNETH P LIPKOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4618 ROUTE 9 SOUTH
HOWELL NJ
07731
US

IV. Provider business mailing address

206 BENT TRAIL
TOMS RIVER NJ
08753
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-5533
  • Fax: 732-367-1325
Mailing address:
  • Phone: 732-349-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03370400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: