Provider Demographics
NPI:1144396987
Name:LIPNACK, ERIC MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:LIPNACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NE 57TH CT
Mailing Address - Street 2:#262
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2820
Mailing Address - Country:US
Mailing Address - Phone:215-796-0081
Mailing Address - Fax:
Practice Address - Street 1:3300 NE 57TH CT
Practice Address - Street 2:#262
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2820
Practice Address - Country:US
Practice Address - Phone:215-796-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006879L208100000X
FLOS9993208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03825Medicare UPIN
004742Medicare PIN