Provider Demographics
NPI:1720142987
Name:LIPKUS, MARC I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:I
Last Name:LIPKUS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ELLIS DRIVE
Mailing Address - Street 2:GREYSTONE PARK PSYCHIATRIC HOSPITAL
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950
Mailing Address - Country:US
Mailing Address - Phone:973-538-1800
Mailing Address - Fax:
Practice Address - Street 1:30 ELLIS DRIVE
Practice Address - Street 2:GREYSTONE PARK PSYCHIATRIC HOSPITAL
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-538-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00200700103T00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR33740Medicare UPIN
NJ709-250Medicare ID - Type Unspecified