Provider Demographics
NPI:1073607040
Name:LICHT, ARNOLD LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:LAWRENCE
Last Name:LICHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:161 ATLANTIC AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6792
Mailing Address - Country:US
Mailing Address - Phone:718-935-0986
Mailing Address - Fax:718-237-4434
Practice Address - Street 1:161 ATLANTIC AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6792
Practice Address - Country:US
Practice Address - Phone:718-935-0986
Practice Address - Fax:718-237-4434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY106199-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00186301Medicaid
B78706Medicare UPIN
NY00186301Medicaid