Basic Information
| Provider Information | |||||||||
| NPI: | 1417041724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIPNER | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | I. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3915 AVENUE V | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112345156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480101 | ||||||||
| FaxNumber: | 7186213133 | ||||||||
| Practice Location | |||||||||
| Address1: | 1435 86TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112283435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480101 | ||||||||
| FaxNumber: | 7186213133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 104189-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 104189 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00181071 | 05 | NY | MEDICAID |