Provider Demographics
NPI:1760487342
Name:LICHTSTEIN, ELLIOTT S
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:S
Last Name:LICHTSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 OLD HOOK RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3200
Mailing Address - Country:US
Mailing Address - Phone:201-664-0201
Mailing Address - Fax:201-666-7970
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:STE 200
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-664-0201
Practice Address - Fax:201-666-7970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04799300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC61433Medicare UPIN
552029BRUMedicare ID - Type Unspecified