Provider Demographics
NPI:1952190423
Name:LIPCHIK, ALEXANDRA JOAN
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JOAN
Last Name:LIPCHIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEATRICE LN
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1002
Mailing Address - Country:US
Mailing Address - Phone:516-650-2384
Mailing Address - Fax:
Practice Address - Street 1:40 BEATRICE LN
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1002
Practice Address - Country:US
Practice Address - Phone:516-650-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86146330133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered