Healthcare Provider Details

I. General information

NPI: 1831110394
Provider Name (Legal Business Name): LYNNE M OPITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDGEWATER ST 1ST FL. LAB
STATEN ISLAND NY
10305-4900
US

IV. Provider business mailing address

1 EDGEWATER ST 6TH FL. PAYER RELATIONS DEPT.
STATEN ISLAND NY
10305-4900
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4130
  • Fax:
Mailing address:
  • Phone: 718-226-1008
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number180442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: