Provider Demographics
NPI:1700982733
Name:LITWAK, BRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:LITWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FIG DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5657
Mailing Address - Country:US
Mailing Address - Phone:631-385-5141
Mailing Address - Fax:631-470-3456
Practice Address - Street 1:255 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1207
Practice Address - Country:US
Practice Address - Phone:516-877-2400
Practice Address - Fax:516-877-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147136207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
147136OtherNY STATE LICENSE NUMBER
147136OtherNY STATE LICENSE NUMBER
BL013D651Medicare ID - Type Unspecified