Provider Demographics
NPI:1205871704
Name:MICHAEL S LIPPE MD, PC
Entity type:Organization
Organization Name:MICHAEL S LIPPE MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-368-4800
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:STE 103A
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-368-4800
Mailing Address - Fax:845-369-1697
Practice Address - Street 1:255 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4817
Practice Address - Country:US
Practice Address - Phone:845-368-4800
Practice Address - Fax:845-369-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01537842Medicaid
NYW8D891Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER