Provider Demographics
NPI:1003873696
Name:LICHTBLAU, SHELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:LICHTBLAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:BOX 1188
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-1645
Mailing Address - Fax:212-534-8894
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:BOX 1188
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-1645
Practice Address - Fax:212-534-8894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075527-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00101437Medicaid
NY125331Medicare ID - Type Unspecified
NYB02130Medicare UPIN