Provider Demographics
NPI:1124197942
Name:LIPSCHULTZ, TODD M (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:LIPSCHULTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-853-8004
Mailing Address - Fax:856-853-8022
Practice Address - Street 1:1007 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-853-8004
Practice Address - Fax:856-853-8022
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054868207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0432925000OtherIBS PPO
326449OtherCOVENTRY
0432925000OtherAMERIHEALTH HMO
2K9209OtherHEALTHNET
0432925000OtherAMERIHEALTH
1271200OtherCIGNA
GLS061OtherOXFORD
0432925000OtherIBS
0432925000OtherKEYSTONE
2577532OtherUNITED HEALTHCARE
2K9209OtherHEALTHNET
E55082Medicare UPIN