Provider Demographics
NPI:1437501541
Name:LIGHTHOUSE ENDOSCOPY, PC
Entity Type:Organization
Organization Name:LIGHTHOUSE ENDOSCOPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-543-8660
Mailing Address - Street 1:1092 JERICHO TPKE
Mailing Address - Street 2:2S
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3003
Mailing Address - Country:US
Mailing Address - Phone:631-543-8660
Mailing Address - Fax:800-557-3140
Practice Address - Street 1:1092 JERICHO TPKE
Practice Address - Street 2:2S
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3003
Practice Address - Country:US
Practice Address - Phone:631-543-8660
Practice Address - Fax:800-557-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153441207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty