Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 270A00505900 | NJ |
NPI | 1003969478 |
---|---|
Provider Name | John G Lipchak |
First Address | Matawan, NJ 07747-9506 |
Second Address | Matawan, NJ 07747-9506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 20/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U10215 | (02) | NJ |