1538120936 NPI number — JENNIE MARIA LIPARI NP-C

Table of content: JENNIE MARIA LIPARI NP-C (NPI 1538120936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538120936 NPI number — JENNIE MARIA LIPARI NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPARI
Provider First Name:
JENNIE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

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:
1538120936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3614 165TH ST
Provider Second Line Business Mailing Address:
2CN
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11358-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-748-2875
Provider Business Mailing Address Fax Number:
718-445-1391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3614 165TH ST
Provider Second Line Business Practice Location Address:
2CN
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11358-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-748-2875
Provider Business Practice Location Address Fax Number:
718-445-1391
Provider Enumeration Date:
03/28/2006

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: 363L00000X , with the licence number:  F302113 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SF484 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6I02491601 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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