Provider Demographics
NPI:1831110394
Name:OPITZ, LYNNE M (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:OPITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEWATER ST
Mailing Address - Street 2:6TH FL. PAYER RELATIONS DEPT.
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4900
Mailing Address - Country:US
Mailing Address - Phone:718-226-1008
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:1 EDGEWATER ST
Practice Address - Street 2:1ST FL. LAB
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4900
Practice Address - Country:US
Practice Address - Phone:718-226-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180442207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY220016391OtherRAILROAD MEDICARE
NYP00685740OtherRAILROAD MEDICARE
NYP00685740 RAILROADMedicare PIN
NYP00685740OtherRAILROAD MEDICARE
F56407Medicare UPIN