Provider Demographics
NPI:1376543017
Name:LIPPMAN, JAY I (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:I
Last Name:LIPPMAN
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 1:828 PELHAMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1024
Mailing Address - Country:US
Mailing Address - Phone:914-636-3600
Mailing Address - Fax:914-636-2118
Practice Address - Street 1:828 PELHAMDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1005
Practice Address - Country:US
Practice Address - Phone:914-636-3600
Practice Address - Fax:914-636-2118
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-08-13
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
NY94565207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00155660Medicaid
NY094565A40OtherHEALTHFIRST
NY4239025OtherAETNA
JL05733810OtherBCBS
NYGS312OtherOXFORD
NYB77925Medicare UPIN
JL05733810OtherBCBS