Provider Demographics
NPI:1508895160
Name:LICHTENSTEIN, RALPH B (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:B
Last Name:LICHTENSTEIN
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 1:1200 WATERS PLACE
Mailing Address - Street 2:STE M108
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-0367
Mailing Address - Country:US
Mailing Address - Phone:718-931-5620
Mailing Address - Fax:718-931-8663
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M-108
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-0367
Practice Address - Country:US
Practice Address - Phone:718-931-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1407752085B0100X, 2085N0700X, 2085N0904X, 2085R0202X, 2085R0203X, 2085U0001X
NY1407552085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140775OtherLICENSE
B19228Medicare UPIN
76A29Medicare ID - Type Unspecified