Healthcare Provider Details

I. General information

NPI: 1396679817
Provider Name (Legal Business Name): YAIRA LIGHTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ROCKAWAY TPKE
CEDARHURST NY
11516-1122
US

IV. Provider business mailing address

561 BURNSIDE AVE
INWOOD NY
11096-1300
US

V. Phone/Fax

Practice location:
  • Phone: 718-868-4808
  • Fax:
Mailing address:
  • Phone: 718-868-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number924767-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: