Provider Demographics
NPI:1033164132
Name:BECKER LIPNER, LISA (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BECKER LIPNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MONTAUK HWY.
Mailing Address - Street 2:PO BOX 9182
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-9182
Mailing Address - Country:US
Mailing Address - Phone:631-758-4444
Mailing Address - Fax:631-758-1984
Practice Address - Street 1:280 MONTAUK HWY.
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1984
Practice Address - Country:US
Practice Address - Phone:631-758-4444
Practice Address - Fax:631-758-1984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ25C81Medicare ID - Type Unspecified
NYQ54254Medicare UPIN