Healthcare Provider Details

I. General information

NPI: 1578545695
Provider Name (Legal Business Name): JEFFREY HOWARD LITWIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20507 HILLSIDE AVE SUITE 18
HOLLIS NY
11423-2220
US

IV. Provider business mailing address

20507 HILLSIDE AVE SUITE 18
HOLLIS NY
11423-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-9605
  • Fax: 718-217-5867
Mailing address:
  • Phone: 718-464-9605
  • Fax: 718-217-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY HOWARD LITWIN
Title or Position: OWNER
Credential: D.P.M.
Phone: 718-464-9605