Provider Demographics
NPI:1821081175
Name:CAROL A IPSEN MD PC
Entity Type:Organization
Organization Name:CAROL A IPSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:IPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-439-5624
Mailing Address - Street 1:1240 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9222
Mailing Address - Country:US
Mailing Address - Phone:518-439-5624
Mailing Address - Fax:518-765-4036
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-439-5624
Practice Address - Fax:518-765-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1499982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000945OtherCDPHP
G708OtherCDPHP
362801OtherMVP
NY10000945OtherCDPHP
B82940Medicare UPIN