Healthcare Provider Details

I. General information

NPI: 1598743445
Provider Name (Legal Business Name): CAROL A IPSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 NEW SCOTLAND RD #204
SLINGERLANDS NY
12159-9222
US

IV. Provider business mailing address

1240 NEW SCOTLAND RD #204
SLINGERLANDS NY
12159-9222
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-5624
  • Fax: 518-765-4036
Mailing address:
  • Phone: 518-439-5624
  • Fax: 518-765-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number149998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: