Provider Demographics
NPI:1952657710
Name:LYMPHEDEMA MANAGEMENT ASSOCIATES INC
Entity Type:Organization
Organization Name:LYMPHEDEMA MANAGEMENT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CLT
Authorized Official - Phone:718-980-5161
Mailing Address - Street 1:97 NEW DORP LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2364
Mailing Address - Country:US
Mailing Address - Phone:718-980-5161
Mailing Address - Fax:718-980-7068
Practice Address - Street 1:97 NEW DORP LN
Practice Address - Street 2:SUITE D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2364
Practice Address - Country:US
Practice Address - Phone:718-980-5161
Practice Address - Fax:718-980-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005609-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization