Provider Demographics
NPI:1467812834
Name:DR MICHAEL E LESSIN
Entity Type:Organization
Organization Name:DR MICHAEL E LESSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARABAJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-470-7130
Mailing Address - Street 1:27005 76TH AVE
Mailing Address - Street 2:DEPARTMENT OF DENTAL MEDICINE
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1402
Mailing Address - Country:US
Mailing Address - Phone:718-470-7130
Mailing Address - Fax:718-470-5423
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:DEPARTMENT OF DENTAL MEDICINE
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7130
Practice Address - Fax:718-470-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053824-1261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02983897Medicaid
NY02983897Medicaid