Healthcare Provider Details

I. General information

NPI: 1881783116
Provider Name (Legal Business Name): JASON S LIPETZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MERRICK AVE
EAST MEADOW NY
11554-4748
US

IV. Provider business mailing address

801 MERRICK AVE
EAST MEADOW NY
11554-4748
US

V. Phone/Fax

Practice location:
  • Phone: 516-393-8941
  • Fax: 516-393-8870
Mailing address:
  • Phone: 516-393-8941
  • Fax: 516-393-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number200830
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: