Healthcare Provider Details

I. General information

NPI: 1437216793
Provider Name (Legal Business Name): LONG ISLAND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 MERRICK RD
BALDWIN NY
11510-3551
US

IV. Provider business mailing address

664 MERRICK RD
BALDWIN NY
11510-3551
US

V. Phone/Fax

Practice location:
  • Phone: 516-771-8123
  • Fax: 516-208-8343
Mailing address:
  • Phone: 516-771-8123
  • Fax: 516-208-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2197411
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RICHARD LIPPMANN
Title or Position: OWNER
Credential: M.D.
Phone: 516-771-8123