1780821132 NPI number — MAMIE LIPARI, M.D. P.C.

Table of content: (NPI 1780821132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780821132 NPI number — MAMIE LIPARI, M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAMIE LIPARI, M.D. P.C.
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:
1780821132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21445 29TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11360-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-701-5941
Provider Business Mailing Address Fax Number:
718-423-7696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20228 45TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11361-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-701-5941
Provider Business Practice Location Address Fax Number:
718-423-7696
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LIPARI
Authorized Official First Name:
MAMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-701-5941

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  190651 , 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: G1000000115 . This is a "PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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