Basic Information
| Provider Information | |||||||||
| NPI: | 1316994296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PHYSICIANS AT LICH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 20FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122563682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 349 HENRY ST | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187801245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | SEPKOWITZ | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ANALYST | ||||||||
| AuthorizedOfficialTelephone: | 7187801245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.