Provider Demographics
NPI:1851980551
Name:LICHTENSTEIN, ISRAEL HARRY
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:HARRY
Last Name:LICHTENSTEIN
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 1:6324 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2934
Mailing Address - Country:US
Mailing Address - Phone:267-488-1945
Mailing Address - Fax:
Practice Address - Street 1:6324 MERIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2934
Practice Address - Country:US
Practice Address - Phone:267-488-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017951E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine