Healthcare Provider Details

I. General information

NPI: 1841897915
Provider Name (Legal Business Name): LSA PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 MADISON AVE
NEW YORK NY
10017-6345
US

IV. Provider business mailing address

286 MADISON AVE
NEW YORK NY
10017-6345
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-470-5056
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-470-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NIELI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 914-376-6100