Provider Demographics
NPI:1902853674
Name:LIPSEY, LEWIS R (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:R
Last Name:LIPSEY
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 1:14 SUTTON PL S
Mailing Address - Street 2:#9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3071
Mailing Address - Country:US
Mailing Address - Phone:212-639-9361
Mailing Address - Fax:
Practice Address - Street 1:51 E 90TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1205
Practice Address - Country:US
Practice Address - Phone:212-828-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77894207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA23416Medicare PIN
NY5Z6441Medicare PIN