Healthcare Provider Details

I. General information

NPI: 1447176565
Provider Name (Legal Business Name): JENNIFER FALLON LIPOF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

150 BAYARD ST APT 6F
BROOKLYN NY
11222-7667
US

V. Phone/Fax

Practice location:
  • Phone: 617-777-3548
  • Fax:
Mailing address:
  • Phone: 617-777-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1969946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: