Provider Demographics
NPI:1891967626
Name:JESSICA LATTMAN MD PLLC
Entity Type:Organization
Organization Name:JESSICA LATTMAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-832-5456
Mailing Address - Street 1:115 EAST 61 ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8184
Mailing Address - Country:US
Mailing Address - Phone:212-832-5456
Mailing Address - Fax:212-421-0176
Practice Address - Street 1:115 EAST 61 ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8184
Practice Address - Country:US
Practice Address - Phone:212-832-5456
Practice Address - Fax:212-421-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY201144207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0499796OtherGHI
7343028002OtherCIGNA
0005065597OtherAETNA
P51053942OtherMULTIPLAN
2C9341OtherHEALTHNET
92T913OtherBC
NY02088122Medicaid
1907314OtherUNITED
P1041236OtherOXFORD
92T912Medicare PIN
NY02088122Medicaid