Provider Demographics
NPI:1962686642
Name:LIPPA, PATRICK V
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:V
Last Name:LIPPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LEROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482
Mailing Address - Country:US
Mailing Address - Phone:585-768-9495
Mailing Address - Fax:585-768-7376
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1443
Practice Address - Country:US
Practice Address - Phone:585-768-9495
Practice Address - Fax:585-768-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000419218001OtherBLUE CROSS & BLUE SHIELD OF WESTERN NEW YORK
NYTINOtherPOMCO
NYTINOtherNEW YORK STATE WORKMAN'S COMP
NY00820001272OtherUNITED HEALTHCARE
NYTINOtherFEDELIS
NY00820001272OtherEMPIRE
NY17351OtherMVP
NYTINOtherNEW YORK STATE INSURANCE FUND
NY000031396201OtherUNIVERA
NY8291475OtherINDEPENDENT HEALTH
NY9008369OtherAETNA
NYTINOtherHUMANA
NY02885894Medicaid
NYP0170059DMOtherEXCELLUS BLUE SHIELD
NYP1070059DSOtherEXCELLUS BLUE CHOICE
NYTINOtherRSMCO
NYTINOtherTRICARE
NYTINOtherHME NATIONAL NETWORK
NYTINOtherCHAMPVA
NY5811550002Medicare NSC
NYTINOtherNEW YORK STATE INSURANCE FUND