MEDICARE: MS. MARNI SHAYNE LIPPEL NP

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	208000000X	Pediatrics Physician	820997	NY
2	363LP0200X	Pediatric Nurse Practitioner	383363	NY

General Provider Information

NPI Number	:	1932870185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARNI SHAYNE LIPPEL NP

Provider Business Mailing Address
First Line	:	17 RENEE PL
Second Line	:
City	:	MASSAPEQUA PARK
State	:	NY
Zip	:	11762-3522
Country	:	US
Telephone Number	:	516-509-8419
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MIDDLE NECK RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1107
Country	:	US
Telephone Number	:	516-466-3311
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	01/13/2023

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