{
"Npi": {
"NPI": "1972612885",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LIPKIN",
"FirstName": "LEONID",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LIPKIN",
"OtherFirstName": "LEON",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 2147",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT MYERS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33902-2147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-343-2052",
"MailingAddressFaxNumber": "239-343-5348",
"FirstLinePracticeLocationAddress": "9981 S HEALTHPARK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT MYERS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33908-3618",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-343-2052",
"PracticeLocationAddressFaxNumber": "239-343-5348",
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "01/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "0101257195",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "ME147364",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "241343",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}