Provider Demographics
NPI:1942383401
Name:DAVID LICHTENSTEIN PHYSICIAN PC
Entity Type:Organization
Organization Name:DAVID LICHTENSTEIN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:LICHTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-318-3434
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160524-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty