Healthcare Provider Details

I. General information

NPI: 1952792681
Provider Name (Legal Business Name): RONY LIPOVETZKY MS, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLATBUSH AVE
BROOKLYN NY
11217-2812
US

IV. Provider business mailing address

300 FLATBUSH AVE
BROOKLYN NY
11217-2812
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-2000
  • Fax:
Mailing address:
  • Phone: 718-622-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: