Healthcare Provider Details

I. General information

NPI: 1437501541
Provider Name (Legal Business Name): LIGHTHOUSE ENDOSCOPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 JERICHO TPKE 2S
COMMACK NY
11725-3003
US

IV. Provider business mailing address

1092 JERICHO TPKE 2S
COMMACK NY
11725-3003
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-8660
  • Fax: 800-557-3140
Mailing address:
  • Phone: 631-543-8660
  • Fax: 800-557-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number153441
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD FELDSTEIN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 631-543-8660