Provider Demographics
NPI:1710967393
Name:LIPETZ, SIMON SHIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:SHIMON
Last Name:LIPETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:74 HAYLOFT LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2634
Mailing Address - Country:US
Mailing Address - Phone:616-484-1117
Mailing Address - Fax:516-484-1116
Practice Address - Street 1:10460 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7301
Practice Address - Country:US
Practice Address - Phone:718-275-4849
Practice Address - Fax:718-275-6381
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2501904OtherGHI
NYQN0059001OtherAMERICHOICE
NY3C0053OtherHEALTHNET
NYDP443OtherOXFORD INSURANCE CO.
NY53K521OtherBLUE CROSS/BLUE SHIELD
NYF37654Medicare UPIN
NYQN0059001OtherAMERICHOICE