Basic Information
| Provider Information | |||||||||
| NPI: | 1518256767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPTON | ||||||||
| FirstName: | ROSS | ||||||||
| MiddleName: | ELIOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 BELLE TERRE RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314740707 | ||||||||
| FaxNumber: | 6314744034 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 BELLE TERRE RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314740707 | ||||||||
| FaxNumber: | 6314744034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2011 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204R00000X | 202189 | NY | N | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine | 204C00000X | 202189 | NY | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | 2084N0400X | 202189 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208VP0014X | 202189 | NY | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2084P2900X | 202189 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
No ID Information.