1982907895 NPI number — THOMAS E LIPIN MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982907895 NPI number — THOMAS E LIPIN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS E LIPIN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1982907895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 JUPITER LAKES BLVD
Provider Second Line Business Mailing Address:
BUILDING 3000, SUITE 202
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-7191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-746-2114
Provider Business Mailing Address Fax Number:
561-746-9583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 JUPITER LAKES BLVD
Provider Second Line Business Practice Location Address:
BUILDING 3000, SUITE 202
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-7191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-746-2114
Provider Business Practice Location Address Fax Number:
561-746-9583
Provider Enumeration Date:
12/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LIPIN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-746-2114

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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