Provider Demographics
NPI:1922774546
Name:LIPPO, JESSICA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LIPPO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LIPPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JESSICA LIPPO, LMT
Mailing Address - Street 1:360 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3217
Mailing Address - Country:US
Mailing Address - Phone:516-384-1217
Mailing Address - Fax:
Practice Address - Street 1:340 VETERANS MEMORIAL HWY STE 10
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4300
Practice Address - Country:US
Practice Address - Phone:631-776-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist