Provider Demographics
NPI:1588119572
Name:KIPPER, MINNA (MSED)
Entity type:Individual
Prefix:MRS
First Name:MINNA
Middle Name:
Last Name:KIPPER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6702
Mailing Address - Country:US
Mailing Address - Phone:718-339-4765
Mailing Address - Fax:718-339-3106
Practice Address - Street 1:1548 E 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6702
Practice Address - Country:US
Practice Address - Phone:718-339-4765
Practice Address - Fax:718-339-3106
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595556051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist