Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 202189 | NY |
N | 2084N0400X | Neurologist | 202189 | NY |
NPI | 1518256767 |
---|---|
Provider Name | Ross Eliott Lipton |
First Address | Port Jefferson, NY 11777-1935 |
Second Address | Port Jefferson, NY 11777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 06/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18213 | (02) | UT |