Healthcare Provider Details

I. General information

NPI: 1194896951
Provider Name (Legal Business Name): LINDENHURST OB-GYN GROUP PC ROBERT J LIPANI MD PRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BRENTWOOD RD
BAYSHORE NY
11706-6923
US

IV. Provider business mailing address

41 BRENTWOOD RD
BAYSHORE NY
11706-6923
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-2446
  • Fax: 631-665-0816
Mailing address:
  • Phone: 631-665-2446
  • Fax: 631-665-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number136230
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT JOHN LIPANI
Title or Position: PRESIDENT
Credential: MD
Phone: 631-665-2446