Healthcare Provider Details

I. General information

NPI: 1932870185
Provider Name (Legal Business Name): MARNI SHAYNE LIPPEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIDDLE NECK RD
GREAT NECK NY
11021-1107
US

IV. Provider business mailing address

17 RENEE PL
MASSAPEQUA PARK NY
11762-3522
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-3311
  • Fax:
Mailing address:
  • Phone: 516-509-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number820997
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: