Provider Demographics
NPI:1861478646
Name:LIPSKY, THERESA R (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:R
Last Name:LIPSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-472-8060
Practice Address - Street 1:4652 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9700
Practice Address - Country:US
Practice Address - Phone:315-492-3403
Practice Address - Fax:315-492-2960
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY193514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG13999Medicare UPIN
NY55290RMedicare PIN
NY080087762Medicare PIN