MEDICARE: DR. LYALL ARNOLD GORENSTEIN

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	189748	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770580565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYALL ARNOLD GORENSTEIN

Provider Business Mailing Address
First Line	:	5A MEDICAL PARK DR
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3516
Country	:	US
Telephone Number	:	845-362-0075
Fax Number	:	845-362-1716

Provider Business Practice Location Address
First Line	:	5A MEDICAL PARK DR
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3516
Country	:	US
Telephone Number	:	845-362-0075
Fax Number	:	845-362-1716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2013

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