Provider Demographics
NPI:1043375728
Name:LIGHTMAN, HYLTON IVAN (MD, DCH, FAAP)
Entity Type:Individual
Prefix:DR
First Name:HYLTON
Middle Name:IVAN
Last Name:LIGHTMAN
Suffix:
Gender:M
Credentials:MD, DCH, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5425
Mailing Address - Country:US
Mailing Address - Phone:718-868-4808
Mailing Address - Fax:718-868-2270
Practice Address - Street 1:601 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5425
Practice Address - Country:US
Practice Address - Phone:718-868-4808
Practice Address - Fax:718-868-2270
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1654552080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01507042Medicaid
NY01507042Medicaid