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General NPI Number Information
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NPI Number | 1952657710
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA MANAGEMENT ASSOCIATES INC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 97 NEW DORP LN SUITE D
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2364
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Country | US
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Telephone | 718-980-5161
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Fax | 718-980-7068
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Provider Business Mailing Address
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Address Line | 97 NEW DORP LN SUITE D
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2364
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Country | US
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Telephone | 718-980-5161
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Fax | 718-980-7068
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH ANN WILLIAMS
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Credential | LMT, CLT
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Telephone | 718-980-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 005609-1
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License Number State | NY
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