Provider Demographics
NPI:1841457967
Name:LICH FACULTY PRACTICE
Entity type:Organization
Organization Name:LICH FACULTY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-780-4997
Mailing Address - Street 1:97 AMITY ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6004
Mailing Address - Country:US
Mailing Address - Phone:718-780-4952
Mailing Address - Fax:718-780-1827
Practice Address - Street 1:97 AMITY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6004
Practice Address - Country:US
Practice Address - Phone:718-780-4952
Practice Address - Fax:718-780-1827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG ISLAND COLLEGE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty