Provider Demographics
NPI:1629453626
Name:LICHTENSTEIN MD, ERIC S (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:LICHTENSTEIN MD
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 1:420 TACONIC RD
Mailing Address - Street 2:C/O MEDICAL CYBERNETICS, INC.
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-2850
Mailing Address - Country:US
Mailing Address - Phone:203-625-7647
Mailing Address - Fax:
Practice Address - Street 1:420 TACONIC RD
Practice Address - Street 2:C/O MEDICAL CYBERNETICS, INC.
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-2850
Practice Address - Country:US
Practice Address - Phone:203-625-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105109207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism