Provider Demographics
NPI:1023398377
Name:JACOB LICHY MD AND THOMAS KOLB MD PC
Entity Type:Organization
Organization Name:JACOB LICHY MD AND THOMAS KOLB MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-879-4488
Mailing Address - Street 1:222 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6001
Mailing Address - Country:US
Mailing Address - Phone:212-879-4488
Mailing Address - Fax:
Practice Address - Street 1:52 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1810
Practice Address - Country:US
Practice Address - Phone:212-879-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty