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General NPI Number Information
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NPI Number | 1134165095
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Entity Type | Organization
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Legal Business Name | ITHACA PALLIATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 172 E KING RD
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City | ITHACA
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State | NY
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Zip | 14850-9403
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Country | US
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Telephone | 607-272-0121
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Fax | 607-272-3785
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Provider Business Mailing Address
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Address Line | 172 E KING RD
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City | ITHACA
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State | NY
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Zip | 14850-9403
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Country | US
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Telephone | 607-272-0121
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Fax | 607-272-3785
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ERIC LESSINGER
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Credential | M.D.
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Telephone | 607-272-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 116788
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License Number State | NY
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