Provider Demographics
NPI:1134118698
Name:LIPPMANN, RICHARD DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:LIPPMANN
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 1:10 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2134
Mailing Address - Country:US
Mailing Address - Phone:516-771-8123
Mailing Address - Fax:516-208-8343
Practice Address - Street 1:664 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3551
Practice Address - Country:US
Practice Address - Phone:516-771-8123
Practice Address - Fax:516-208-8343
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219741-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY126270OtherVYTRA
NYAA72028OtherMDNY
NY02368945Medicaid
NY521Z01OtherBLUE CROSS
NY2681845OtherAETNA
NY4C4391OtherHEALTHNET
NY1000033951OtherAFFINITY
NY2697292OtherGHI
NYP2532060OtherOXFORD
NY562Y91Medicare ID - Type Unspecified
NY2681845OtherAETNA