| Medicine Specialty Group at Lich | |
|
97 Amity St Brooklyn NY 11201-6004 | |
| (718) 780-2155 | |
| Not Available |
| Full Name | Medicine Specialty Group at Lich |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 97 Amity St, Brooklyn, New York |
| Authorized Official Name and Position | Vladimir Privman (MANAGING EMPLOYEE) |
| Authorized Official Contact | 7187802155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicine Specialty Group at Lich 160 Water St 20fl New York NY 10038-4922 Ph: (212) 256-3682 | Medicine Specialty Group at Lich 97 Amity St Brooklyn NY 11201-6004 Ph: (718) 780-2155 |
| NPI Number | 1003863820 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 11/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003863820 | NPI | - | NPPES |
| 02420102 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (NU) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | (NU) | Primary |
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