Provider Demographics
NPI:1538120936
Name:LIPARI, JENNIE MARIA (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIA
Last Name:LIPARI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 165TH ST
Mailing Address - Street 2:2CN
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2042
Mailing Address - Country:US
Mailing Address - Phone:917-748-2875
Mailing Address - Fax:718-445-1391
Practice Address - Street 1:3614 165TH ST
Practice Address - Street 2:2CN
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2042
Practice Address - Country:US
Practice Address - Phone:917-748-2875
Practice Address - Fax:718-445-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSF484OtherEMPIRE BC/BS
NY6I02491601Medicaid
NY6I02491601Medicaid
NYSF484OtherEMPIRE BC/BS