Provider Demographics
NPI:1528014214
Name:LIPARI, MAMIE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAMIE
Middle Name:A
Last Name:LIPARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20228 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2540
Mailing Address - Country:US
Mailing Address - Phone:718-701-5941
Mailing Address - Fax:718-423-7696
Practice Address - Street 1:20228 45TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2540
Practice Address - Country:US
Practice Address - Phone:718-701-5941
Practice Address - Fax:718-423-7696
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1906512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001039OtherPTAN
NY01761242Medicaid
NY01761242Medicaid
G47724Medicare UPIN