Healthcare Provider Details

I. General information

NPI: 1710397245
Provider Name (Legal Business Name): MARISSA LIPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLUMBIA UNIVERSITY MEDICAL CENTER - CHONY 3959 BROADWAY, CHN 11TH FLOOR, ROOM 1115
NEW YORK NY
10032
US

IV. Provider business mailing address

550 1ST AVE NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5825
  • Fax: 212-342-0518
Mailing address:
  • Phone: 212-263-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number288143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: