Provider Demographics
NPI:1598862286
Name:LICHTENSTEIN, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:19213 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1865
Mailing Address - Country:US
Mailing Address - Phone:718-468-9800
Mailing Address - Fax:
Practice Address - Street 1:19213 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1865
Practice Address - Country:US
Practice Address - Phone:718-468-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201291-1207WX0110X
NY201291207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY186114OtherWELLCARE
NY1724017OtherFIRST HEALTH
NY204B51OtherEMPIRE BLUE CROSS BLUE SHIELD
NY20129101OtherNEIGHBORHOOD HEALTH PROVIDERS
NY2056471000OtherAMERIHEALTH HMO/POS
NY17P6361OtherNEW YORK PRESBYTRIAN
NY2539615OtherAETNA
NY201291-A40OtherHEALTHFIRST
NYP1958585OtherOXFORD
NY040426018533OtherCENTERCARE
NY4112463011OtherCIGNA
NY040426018533OtherFIDELIS
NY10204475OtherAMERIGROUP
NY1364086OtherAMERIHEALTH PPO
NY040426018533OtherFIDELIS
NY04772Medicare ID - Type Unspecified