Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00107200 | NJ |
NPI | 1073532974 |
---|---|
Provider Name | Robert M Lipp |
First Address | Old Bridge, NJ 08857-1892 |
Second Address | Old Bridge, NJ 08857-1892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44961 | (02) | NJ |