Provider Demographics
NPI:1295846061
Name:LIPPMAN, MARIE A (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CLIFFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506
Mailing Address - Country:US
Mailing Address - Phone:516-359-9599
Mailing Address - Fax:
Practice Address - Street 1:55 CLIFFIELD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1210
Practice Address - Country:US
Practice Address - Phone:516-359-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1801732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466935Medicaid
NYF73689Medicare UPIN
NY331221Medicare ID - Type Unspecified