Provider Demographics
NPI:1790143386
Name:DIRECT HOUSE MEDICAL PLLC
Entity Type:Organization
Organization Name:DIRECT HOUSE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LESSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-515-7819
Mailing Address - Street 1:119 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4135
Mailing Address - Country:US
Mailing Address - Phone:917-515-7819
Mailing Address - Fax:
Practice Address - Street 1:119 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4135
Practice Address - Country:US
Practice Address - Phone:917-515-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255920159201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty