Provider Demographics
NPI:1629135629
Name:LACHMANN, JUSTINE S (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:S
Last Name:LACHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 MINEOLA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4074
Mailing Address - Country:US
Mailing Address - Phone:516-663-2765
Mailing Address - Fax:516-663-2054
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4074
Practice Address - Country:US
Practice Address - Phone:516-663-2765
Practice Address - Fax:516-663-2054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206120207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195811Medicaid
NY470Q01Medicare ID - Type Unspecified
NYH73469Medicare UPIN