Provider Demographics
NPI:1427264704
Name:LIPPERT, MARISSA TUDOR (MS, RD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:TUDOR
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 14TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 W 14TH ST
Practice Address - Street 2:4TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7307
Practice Address - Country:US
Practice Address - Phone:646-784-6865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY933707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered