MEDICARE: DR. MATTHEW R. LIPPMANN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	05-45311	KS
2	207RC0000X	Cardiovascular Disease Physician	327444	NY

General Provider Information

NPI Number	:	1225456171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW R. LIPPMANN DO

Provider Business Mailing Address
First Line	:	39 BRENTWOOD RD STE 101
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8031
Country	:	US
Telephone Number	:	631-590-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 BRENTWOOD RD STE 101
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8031
Country	:	US
Telephone Number	:	631-590-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	11/20/2024

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