Provider Demographics
NPI:1477699379
Name:LIPTON, BRADLEY BARON (DC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:BARON
Last Name:LIPTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W 34TH ST
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3011
Mailing Address - Country:US
Mailing Address - Phone:212-686-4040
Mailing Address - Fax:212-686-3718
Practice Address - Street 1:1 W 34TH ST
Practice Address - Street 2:SUITE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3011
Practice Address - Country:US
Practice Address - Phone:212-686-4040
Practice Address - Fax:212-686-3718
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLX010585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87779Medicare UPIN
NYX6K991Medicare ID - Type Unspecified