1336343102 NPI number — AVRON H LIPSCHITZ MD

Table of content: AVRON H LIPSCHITZ MD (NPI 1336343102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336343102 NPI number — AVRON H LIPSCHITZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSCHITZ
Provider First Name:
AVRON
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1336343102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 SE MONTEREY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34996-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-324-8197
Provider Business Mailing Address Fax Number:
772-324-8143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 SE MONTEREY COMMONS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-324-8197
Provider Business Practice Location Address Fax Number:
772-324-8143
Provider Enumeration Date:
06/13/2007

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: 208200000X , with the licence number:  ME108557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BP1-0017846 . This is a "INSTITUTIONAL PERMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1235410549 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12247361 . This is a "HCAQ" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004417800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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