Healthcare Provider Details

I. General information

NPI: 1104896901
Provider Name (Legal Business Name): STUART M LICHTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COMMACK RD
COMMACK NY
11725-5404
US

IV. Provider business mailing address

633 3RD AVE BOX 3
NEW YORK NY
10017-6706
US

V. Phone/Fax

Practice location:
  • Phone: 646-227-3813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number146615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: