Provider Demographics
NPI:1083625024
Name:LIPTON, DAVID NEIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NEIL
Last Name:LIPTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2026
Mailing Address - Country:US
Mailing Address - Phone:732-758-9494
Mailing Address - Fax:732-758-9494
Practice Address - Street 1:214 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2026
Practice Address - Country:US
Practice Address - Phone:732-758-9494
Practice Address - Fax:732-758-9494
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02167103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ679488Medicare ID - Type Unspecified