MEDICARE: LWHMEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	252168-1	NY

General Provider Information

NPI Number	:	1184968232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LWHMEDICAL PC

Provider Business Mailing Address
First Line	:	1811 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1406
Country	:	US
Telephone Number	:	718-518-1133
Fax Number	:	718-518-1244

Provider Business Practice Location Address
First Line	:	1811 HONE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1406
Country	:	US
Telephone Number	:	718-518-1133
Fax Number	:	718-518-1244

Authorized Official
Title or Position	:	OWNER
Name	:	LARISA SHPITALNIK
Credential	:	MD
Telephone Number	:	718-518-1133

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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