Provider Demographics
NPI:1598884074
Name:LIPPIN, JONATHAN D (PC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:LIPPIN
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 63RD ST
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7674
Mailing Address - Country:US
Mailing Address - Phone:212-759-8281
Mailing Address - Fax:212-750-2669
Practice Address - Street 1:210 E 63RD ST
Practice Address - Street 2:1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7674
Practice Address - Country:US
Practice Address - Phone:212-759-8281
Practice Address - Fax:212-750-2669
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice