=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902988033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID NEIL LIFSCHUTZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 FRANKLIN AVE
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-374-2992
-----------------------------------------------------
Fax | 516-295-9364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 CEDAR AVE
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-569-3522
-----------------------------------------------------
Fax | 516-569-1406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 232380
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------