Healthcare Provider Details

I. General information

NPI: 1609810829
Provider Name (Legal Business Name): HAROLD LIFSHUTZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19WEST 34TH ST PENTHOUSE SUITES
NEW YORK CITY NY
10001
US

IV. Provider business mailing address

41 CHATHAM RD
NEW ROCHELLE NY
10804-2535
US

V. Phone/Fax

Practice location:
  • Phone: 914-654-8763
  • Fax:
Mailing address:
  • Phone: 914-654-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8003-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: