1376596445 NPI number — RAYMOND LIPPERT MD

Table of content: RAYMOND LIPPERT MD (NPI 1376596445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376596445 NPI number — RAYMOND LIPPERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPPERT
Provider First Name:
RAYMOND
Provider Middle Name:
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:
1376596445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 JOHN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-338-7125
Provider Business Mailing Address Fax Number:
845-331-9388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 JOHN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-338-7125
Provider Business Practice Location Address Fax Number:
845-331-9388
Provider Enumeration Date:
05/18/2006

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: 207R00000X , with the licence number:  1203821 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , with the licence number: 1203821 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 141610785 . This is a "KINGSTON TRUST FUND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 287258 . This is a "MVP ENDOCRINOLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 137182 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110227140 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141610785 . This is a "CATSKILL AREA SCHOOLS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001199 . This is a "COPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00505739 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117258 . This is a "MVP INTERNAL MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30105100 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141610785 . This is a "AARP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6011874 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000033697 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000401428004 . This is a "BS OF NE NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141610785 . This is a "NYS EMPLOYEE BENEFITS" identifier . This identifiers is of the category "OTHER".




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