Provider Demographics
NPI:1457440554
Name:LIPMAN, JEFF ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:ROBERT
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2958
Mailing Address - Country:US
Mailing Address - Phone:631-351-1116
Mailing Address - Fax:631-351-1172
Practice Address - Street 1:152 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2958
Practice Address - Country:US
Practice Address - Phone:631-351-1116
Practice Address - Fax:631-351-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice