Provider Demographics
NPI:1235222985
Name:EDWARD J. LIPINSKY, MD, PC
Entity Type:Organization
Organization Name:EDWARD J. LIPINSKY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIPINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-3727
Mailing Address - Street 1:300 EAST MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2900
Mailing Address - Country:US
Mailing Address - Phone:631-265-3727
Mailing Address - Fax:631-265-6263
Practice Address - Street 1:300 EAST MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2900
Practice Address - Country:US
Practice Address - Phone:631-265-3727
Practice Address - Fax:631-265-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXTTV1Medicare PIN