Provider Demographics
NPI:1073532974
Name:LIPP, ROBERT M (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:LIPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 COUNTY ROAD 516
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1892
Mailing Address - Country:US
Mailing Address - Phone:732-679-4330
Mailing Address - Fax:732-679-4777
Practice Address - Street 1:2433 COUNTY ROAD 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1892
Practice Address - Country:US
Practice Address - Phone:732-679-4330
Practice Address - Fax:732-679-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00107200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44961Medicare UPIN
NJ440572Medicare ID - Type UnspecifiedPROVIDER NUMBER