Provider Demographics
NPI:1790785178
Name:LIPMAN, MARVIN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:M
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 HEATHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4523
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:
Practice Address - Street 1:259 HEATHCOTE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4523
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY77180207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00563300Medicaid
NYB09122Medicare UPIN
NY165931Medicare ID - Type Unspecified