1598862286 NPI number — DR. ERIC LICHTENSTEIN M.D.

Table of content: DR. ERIC LICHTENSTEIN M.D. (NPI 1598862286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598862286 NPI number — DR. ERIC LICHTENSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LICHTENSTEIN
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598862286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19213 UNION TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11366-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-468-9800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19213 UNION TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11366-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-468-9800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207WX0110X , with the licence number:  201291-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 201291 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 186114 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1724017 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 204B51 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20129101 . This is a "NEIGHBORHOOD HEALTH PROVIDERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2056471000 . This is a "AMERIHEALTH HMO/POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17P6361 . This is a "NEW YORK PRESBYTRIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2539615 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201291-A40 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1958585 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426018533 . This is a "CENTERCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4112463011 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426018533 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10204475 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1364086 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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