Healthcare Provider Details

I. General information

NPI: 1952461097
Provider Name (Legal Business Name): JEFFREY LIPTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIJMC PEDIATRIC HEM ONC 269 01 76TH AVENUE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

LIJMC PEDIATRIC HEM ONC LIJMC PEDIATRIC HEM ONC
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3460
  • Fax:
Mailing address:
  • Phone: 718-470-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number160647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: