Provider Demographics
NPI:1649242868
Name:LIPP, MATTHEW IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IVAN
Last Name:LIPP
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 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2431
Mailing Address - Country:US
Mailing Address - Phone:973-635-0800
Mailing Address - Fax:973-635-6254
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2431
Practice Address - Country:US
Practice Address - Phone:973-635-0800
Practice Address - Fax:973-635-6254
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07739500208100000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI14574Medicare UPIN
NJ528793Medicare ID - Type Unspecified