Healthcare Provider Details

I. General information

NPI: 1780646125
Provider Name (Legal Business Name): ERIC LEHNERT ATC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SOUTHERN BLVD
NESCONSET NY
11767-1043
US

IV. Provider business mailing address

27 MARION DR
LAKE RONKONKOMA NY
11779-3007
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-3363
  • Fax: 631-361-3579
Mailing address:
  • Phone: 631-467-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340699
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: