MEDICARE: DR. DAVID LICHTENSTEIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	07797	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137876	OTHER	NY	VALUEOPTIONS

General Provider Information

NPI Number	:	1285792333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LICHTENSTEIN PH.D.

Provider Business Mailing Address
First Line	:	80 UNIVERSITY PL FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4564
Country	:	US
Telephone Number	:	212-929-6208
Fax Number	:	212-929-6326

Provider Business Practice Location Address
First Line	:	80 UNIVERSITY PL FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4564
Country	:	US
Telephone Number	:	212-929-6208
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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