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General NPI Number Information
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NPI Number | 1083492128
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Entity Type | Organization
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Legal Business Name | LAKE SUCCESS HEALTH MEDICAL WELLNESS PC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 2001 MARCUS AVE STE W95
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-2052
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Country | US
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Telephone | 917-524-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 295 MADISON AVE RM 407
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City | NEW YORK
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State | NY
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Zip | 10017-6438
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Country | US
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Telephone | 914-960-5578
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. JEFFREY ROSEN
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Credential | CFO
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Telephone | 914-860-5578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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