Provider Demographics
NPI:1932151180
Name:LIPETZ, DAVID IAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:IAN
Last Name:LIPETZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2136
Mailing Address - Country:US
Mailing Address - Phone:516-513-1510
Mailing Address - Fax:516-513-1511
Practice Address - Street 1:300 ROBBINS LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6012
Practice Address - Country:US
Practice Address - Phone:516-513-1510
Practice Address - Fax:516-513-1511
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026960-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24M71Medicare PIN