Provider Demographics
NPI:1689778243
Name:DAVID LIPETZ PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:DAVID LIPETZ PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:LIPETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-248-4264
Mailing Address - Street 1:1399 FRANKLIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-7400
Mailing Address - Country:US
Mailing Address - Phone:516-248-4264
Mailing Address - Fax:516-248-4265
Practice Address - Street 1:1399 FRANKLIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-7400
Practice Address - Country:US
Practice Address - Phone:516-248-4264
Practice Address - Fax:516-248-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24R91OtherBLUE CROSS BLUE SHIELD
NYQ7WTW1Medicare PIN
NY5911310001Medicare NSC