MEDICARE: DAVID LICHTENSTEIN PHYSICIAN 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	207R00000X	Internal Medicine Physician	160524-1	NY

General Provider Information

NPI Number	:	1942383401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID LICHTENSTEIN PHYSICIAN PC

Provider Business Mailing Address
First Line	:	431 BEACH 129 STREET
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1516
Country	:	US
Telephone Number	:	718-318-3434
Fax Number	:	718-318-3723

Provider Business Practice Location Address
First Line	:	431 BEACH 129 STREET
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1516
Country	:	US
Telephone Number	:	718-318-3434
Fax Number	:	718-318-3723

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID IRA LICHTENSTEIN
Credential	:	M.D.
Telephone Number	:	718-318-3434

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/22/2014

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