Basic Information
| Provider Information | |||||||||
| NPI: | 1184670556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LICHFPP PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 20 FLOORE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122563682 | ||||||||
| FaxNumber: | 2122563538 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 AMITY STREET | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112011601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183985705 | ||||||||
| FaxNumber: | 7183985709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | CRENESSE | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING EMPLOYEE | ||||||||
| AuthorizedOfficialTelephone: | 2122563682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.