Provider Demographics
NPI:1134288426
Name:MACHENEH MEDICAL
Entity Type:Organization
Organization Name:MACHENEH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-430-0280
Mailing Address - Street 1:1478 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:641 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12758
Practice Address - Country:US
Practice Address - Phone:917-430-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123563174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974314Medicaid
NY00974314Medicaid
NYC08619Medicare UPIN