Provider Demographics
NPI:1518256767
Name:LIPTON, ROSS ELIOTT (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:ELIOTT
Last Name:LIPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 BELLE TERRE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1935
Mailing Address - Country:US
Mailing Address - Phone:631-474-0707
Mailing Address - Fax:631-474-4034
Practice Address - Street 1:635 BELLE TERRE RD STE 209
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-474-0707
Practice Address - Fax:631-474-4034
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202189204R00000X, 204C00000X, 2084N0400X, 208VP0014X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH18213Medicare UPIN