Provider Demographics
NPI:1194829291
Name:LIPP, ALAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:LIPP
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 1:300 OLD COUNTRY ROAD SUITE 31
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-294-9380
Mailing Address - Fax:516-294-5351
Practice Address - Street 1:300 OLD COUNTRY ROAD SUITE 31
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-294-9380
Practice Address - Fax:516-294-5351
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193508207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831085Medicaid
G45720Medicare UPIN
W23031Medicare ID - Type Unspecified