Provider Demographics
NPI:1770580565
Name:GORENSTEIN, LYALL ARNOLD
Entity type:Individual
Prefix:DR
First Name:LYALL
Middle Name:ARNOLD
Last Name:GORENSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5A MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3516
Mailing Address - Country:US
Mailing Address - Phone:845-362-0075
Mailing Address - Fax:845-362-1716
Practice Address - Street 1:5A MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3516
Practice Address - Country:US
Practice Address - Phone:845-362-0075
Practice Address - Fax:845-362-1716
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189748208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01408933Medicaid
F36804Medicare UPIN
NYA400073758Medicare PIN
NY77K7395181Medicare PIN