Provider Demographics
NPI:1831171131
Name:LITWIN, JEFFREY HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:LITWIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20507 HILLSIDE AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2220
Mailing Address - Country:US
Mailing Address - Phone:718-464-9605
Mailing Address - Fax:718-217-5867
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2220
Practice Address - Country:US
Practice Address - Phone:718-464-9605
Practice Address - Fax:718-217-5867
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO3044213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00490184Medicaid
442480291OtherRAILROAD MEDICARE PIN
T22018Medicare UPIN
442480291OtherRAILROAD MEDICARE PIN
442480291Medicare PIN
405962001Medicare NSC