MEDICARE: LSA PHYSICIANS PC

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1841897915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSA PHYSICIANS PC

Provider Business Mailing Address
First Line	:	286 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6345
Country	:	US
Telephone Number	:	914-376-6100
Fax Number	:	914-470-5056

Provider Business Practice Location Address
First Line	:	286 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6345
Country	:	US
Telephone Number	:	914-376-6100
Fax Number	:	914-470-5056

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MELISSA NIELI
Credential	:
Telephone Number	:	914-376-6100

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	10/02/2020

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