Provider Demographics
NPI:1801827589
Name:LICHTENSTEIN, DAVID IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IRA
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 1:431 BEACH 129 STREET
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1516
Mailing Address - Country:US
Mailing Address - Phone:718-318-3434
Mailing Address - Fax:718-318-3723
Practice Address - Street 1:431 BEACH 129 STREET
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1516
Practice Address - Country:US
Practice Address - Phone:718-318-3434
Practice Address - Fax:718-318-3723
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160524-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01057643Medicaid
NYE14730Medicare UPIN
NY01057643Medicaid