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General NPI Number Information
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NPI Number | 1134288426
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Entity Type | Organization
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Legal Business Name | MACHENEH MEDICAL
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 641 KNICKERBOCKER RD
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City | LIVINGSTON
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State | NY
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Zip | 12758
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Country | US
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Telephone | 917-430-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 1478 E 15TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-6602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | LAZAR FRUCHTER
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Credential |
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Telephone | 917-430-0280
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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 | 123563
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License Number State | NY
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