Provider Demographics
NPI:1134378581
Name:LIPPMAN, JODIE (PT)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E 11TH ST
Mailing Address - Street 2:APT B2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4698
Mailing Address - Country:US
Mailing Address - Phone:212-387-7989
Mailing Address - Fax:
Practice Address - Street 1:171 MADISON AVE
Practice Address - Street 2:SUITE 1600
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:212-213-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist