Provider Demographics
NPI:1720242514
Name:FORCHHEIMER, ILANA LINDSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:LINDSAY
Last Name:FORCHHEIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2830
Mailing Address - Country:US
Mailing Address - Phone:631-265-2580
Mailing Address - Fax:
Practice Address - Street 1:329 E MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2830
Practice Address - Country:US
Practice Address - Phone:631-265-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255460207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY255460Medicaid