Provider Demographics
NPI:1417946963
Name:BROWNSTEIN, LANCE JEFFERY (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:JEFFERY
Last Name:BROWNSTEIN
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 1:34 CHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1341
Mailing Address - Country:US
Mailing Address - Phone:315-853-5550
Mailing Address - Fax:315-853-5581
Practice Address - Street 1:34 CHENANGO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1341
Practice Address - Country:US
Practice Address - Phone:315-853-5550
Practice Address - Fax:315-853-5581
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01458584Medicaid
NY01458584Medicaid
NYF34142Medicare UPIN