Provider Demographics
NPI:1437471232
Name:LIPPER, EVELYN GRUSS
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:GRUSS
Last Name:LIPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:GRUSS
Other - Last Name:LIPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2423
Mailing Address - Country:US
Mailing Address - Phone:212-486-0473
Mailing Address - Fax:212-204-5516
Practice Address - Street 1:505 E 70TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:646-434-8023
Practice Address - Fax:212-204-5516
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1145142080P0006X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics