Provider Demographics
NPI:1881324507
Name:LIPINSKI, KELLY (LAC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LIPINSKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1295 SMITHTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1295 SMITHTOWN AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2133
Practice Address - Country:US
Practice Address - Phone:631-464-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007157-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist