Provider Demographics
NPI:1295090173
Name:LIPIEC, JENNIFER ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:LIPIEC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RIVERSIDE BLVD
Mailing Address - Street 2:309
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 CENTRAL PARK W
Practice Address - Street 2:REGINALD G MONCRIEFF
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4198
Practice Address - Country:US
Practice Address - Phone:212-580-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice