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General NPI Number Information
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NPI Number | 1932870185
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Entity Type | Individual
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Provider Name | MARNI SHAYNE LIPPEL NP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 200 MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1107
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Country | US
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Telephone | 516-466-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 17 RENEE PL
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3522
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Country | US
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Telephone | 516-509-8419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 820997
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383363
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License Number State | NY
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