Provider Demographics
NPI:1417041724
Name:LIPNER, HENRY I (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:I
Last Name:LIPNER
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 1:3915 AVENUE V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5156
Mailing Address - Country:US
Mailing Address - Phone:718-648-0101
Mailing Address - Fax:718-621-3133
Practice Address - Street 1:1435 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3435
Practice Address - Country:US
Practice Address - Phone:718-648-0101
Practice Address - Fax:718-621-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104189-1207RN0300X
NY104189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00181071Medicaid
NYB18849Medicare UPIN
NY703711Medicare PIN