1962686642 NPI number — MR. PATRICK V. LIPPA

Table of content: MR. PATRICK V. LIPPA (NPI 1962686642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962686642 NPI number — MR. PATRICK V. LIPPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPPA
Provider First Name:
PATRICK
Provider Middle Name:
V.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962686642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-768-9495
Provider Business Mailing Address Fax Number:
585-768-7376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE ROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14482-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-768-9495
Provider Business Practice Location Address Fax Number:
585-768-7376
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000419218001 . This is a "BLUE CROSS & BLUE SHIELD OF WESTERN NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "POMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "NEW YORK STATE WORKMAN'S COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00820001272 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "FEDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00820001272 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17351 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "NEW YORK STATE INSURANCE FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000031396201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8291475 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9008369 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02885894 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P0170059DM . This is a "EXCELLUS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1070059DS . This is a "EXCELLUS BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "RSMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "TRICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "HME NATIONAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TIN . This is a "CHAMPVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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