Organization Active NPI

Simon Lipetz MD. P.C

  • Legal Medicine
  • Forest Hills, NY
National Provider Identifier
1235338138
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
186190 Issued in NY
Legal business name
SIMON LIPETZ MD. P.C
Practice address
104-60 Queens Blvd
Suite CH
Forest Hills, NY 11375
Phone
(718) 275-4849
Fax
(718) 275-6381
NPI assigned
Jul 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Simon LipetzNPI 1710967393
Title
Owner
Phone
(718) 275-4849

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X 186190 NY Primary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X 107463 NY
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X 458751 NY
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

104-60 Queens Blvd
Suite CH
Forest Hills, NY 11375

Mailing address

104-60 Queens Blvd.
Suite CH
Forest Hills, NY 11375
Phone (718) 275-4849

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080606000687 NY Part B Supplier - Clinic/Group Practice 4082784772 Receives reassigned benefits from 4 practitioners
Practice locations: Forest Hills, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0865466Simon Lipetz MD PC104-60 Queens Blvd, Forest Hills, NY 11375Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1235338138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104-60 QUEENS BLVD.",
            "address_2": "SUITE CH",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "11375",
            "telephone_number": "718-275-4849",
            "fax_number": "718-275-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104-60 QUEENS BLVD",
            "address_2": "SUITE CH",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "11375",
            "telephone_number": "718-275-4849",
            "fax_number": "718-275-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMON LIPETZ MD. P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "LIPETZ",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-275-4849"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "186190",
            "primary": true
        },
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "107463",
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": "NY",
            "license": "458751",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.