Healthcare Provider Details

I. General information

NPI: 1184670556
Provider Name (Legal Business Name): LICHFPP PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 AMITY STREET
BROOKLYN NY
11201-1601
US

IV. Provider business mailing address

160 WATER ST 20 FLOORE
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 718-398-5705
  • Fax: 718-398-5709
Mailing address:
  • Phone: 212-256-3682
  • Fax: 212-256-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNE CRENESSE
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 212-256-3682