Healthcare Provider Details

I. General information

NPI: 1598862286
Provider Name (Legal Business Name): ERIC LICHTENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19213 UNION TPKE
FRESH MEADOWS NY
11366-1865
US

IV. Provider business mailing address

19213 UNION TPKE
FRESH MEADOWS NY
11366-1865
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-9800
  • Fax:
Mailing address:
  • Phone: 718-468-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number201291
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number201291-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: