Provider Demographics
NPI:1265525778
Name:LIPSY, SUSAN (RN MS CUNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:LIPSY
Suffix:
Gender:F
Credentials:RN MS CUNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1155
Mailing Address - Country:US
Mailing Address - Phone:315-478-4185
Mailing Address - Fax:315-478-0840
Practice Address - Street 1:739 IRVING AVENUE
Practice Address - Street 2:SUITE 600
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-471-0190
Practice Address - Fax:315-471-0170
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301037363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB8280Medicare ID - Type UnspecifiedMEDICARE NUMBER
NYS28831Medicare UPIN