Provider Demographics
NPI:1063856904
Name:LIPMAN, BENJAMIN (PMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:PMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3455
Mailing Address - Country:US
Mailing Address - Phone:963-218-6394
Mailing Address - Fax:973-218-6351
Practice Address - Street 1:899 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3455
Practice Address - Country:US
Practice Address - Phone:963-218-6394
Practice Address - Fax:973-218-6351
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist