Healthcare Provider Details

I. General information

NPI: 1225130511
Provider Name (Legal Business Name): LISA M. RIMPEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DRIVE SUITE 200
EAST SETAUKET NY
11794-9254
US

IV. Provider business mailing address

4 TECHNOLOGY DRIVE SUITE 200
EAST SETAUKET NY
11733-9254
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4686
  • Fax: 631-444-4622
Mailing address:
  • Phone: 631-444-4686
  • Fax: 631-444-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number256927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: