MEDICARE: TEVIA LIPITZ,M.D.,P.C.

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	207K00000X	Allergy & Immunology Physician	089366	NY

General Provider Information

NPI Number	:	1598027757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEVIA LIPITZ,M.D.,P.C.

Provider Business Mailing Address
First Line	:	250 MAPLE AVE
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-4534
Country	:	US
Telephone Number	:	631-724-3375
Fax Number	:	631-360-0174

Provider Business Practice Location Address
First Line	:	250 MAPLE AVE
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-4534
Country	:	US
Telephone Number	:	631-724-3375
Fax Number	:	631-360-0174

Authorized Official
Title or Position	:	PRESIDENT PHYSICIAN
Name	:	DR. TEVIA LIPITZ
Credential	:	M.D.
Telephone Number	:	631-724-3375

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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