MEDICARE: FORGE MEDICAL GROUP, LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1811561855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORGE MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	10 BANK ST STE 830
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-1952
Country	:	US
Telephone Number	:	646-709-6883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 WESTCHESTER AVE STE N-006
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3550
Country	:	US
Telephone Number	:	914-539-7600
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	DANIEL LENZO
Credential	:
Telephone Number	:	646-709-6883

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	01/30/2024

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