Provider Demographics
NPI:1558683359
Name:LIPP, MARC HOWARD (BS)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:HOWARD
Last Name:LIPP
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6346
Mailing Address - Country:US
Mailing Address - Phone:718-648-5999
Mailing Address - Fax:718-769-4295
Practice Address - Street 1:589 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6346
Practice Address - Country:US
Practice Address - Phone:718-648-5999
Practice Address - Fax:718-769-4295
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00840006Medicaid