Provider Demographics
NPI:1497721591
Name:LIPEL, ALEKSANDR (PT)
Entity Type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:LIPEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1218
Mailing Address - Country:US
Mailing Address - Phone:917-612-3971
Mailing Address - Fax:718-934-3330
Practice Address - Street 1:3715 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1218
Practice Address - Country:US
Practice Address - Phone:917-612-3971
Practice Address - Fax:718-934-3330
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02202940Medicaid
NY02202940Medicaid