Provider Demographics
NPI:1437216793
Name:LONG ISLAND PEDIATRICS
Entity Type:Organization
Organization Name:LONG ISLAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-771-8123
Mailing Address - Street 1:664 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3551
Mailing Address - Country:US
Mailing Address - Phone:516-771-8123
Mailing Address - Fax:516-208-8343
Practice Address - Street 1:664 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3551
Practice Address - Country:US
Practice Address - Phone:516-771-8123
Practice Address - Fax:516-208-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2197411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty