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General NPI Number Information
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NPI Number | 1184968232
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Entity Type | Organization
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Legal Business Name | LWHMEDICAL PC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1811 HONE AVE
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City | BRONX
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State | NY
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Zip | 10461-1406
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Country | US
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Telephone | 718-518-1133
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Fax | 718-518-1244
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Provider Business Mailing Address
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Address Line | 1811 HONE AVE
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City | BRONX
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State | NY
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Zip | 10461-1406
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Country | US
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Telephone | 718-518-1133
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Fax | 718-518-1244
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Authorized Official
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Title or Position | OWNER
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Name | LARISA SHPITALNIK
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Credential | MD
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Telephone | 718-518-1133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 252168-1
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License Number State | NY
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