Healthcare Provider Details

I. General information

NPI: 1467598839
Provider Name (Legal Business Name): MICHELLE LEE WIDLITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 43RD ST SUITE 1305
NEW YORK NY
10017-4707
US

IV. Provider business mailing address

211 E 43RD ST SUITE 1305
NEW YORK NY
10017-4707
US

V. Phone/Fax

Practice location:
  • Phone: 212-490-1348
  • Fax:
Mailing address:
  • Phone: 212-490-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number218963-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218963-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: