# LAKE SUCCESS HEALTH MEDICAL WELLNESS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083492128
- **Authorized official:** MR. JEFFREY ROSEN CFO (CFO)
- **Authorized official phone:** (914) 860-5578

## Contact information

- **Practice address:** 2001 MARCUS AVE STE W95, NEW HYDE PARK, NY 11042-2052
- **Practice address phone:** (917) 524-7246
- **Mailing address:** 295 MADISON AVE RM 407, NEW YORK, NY 10017-6438
- **Mailing address phone:** (914) 960-5578

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2023
- **Last updated:** 09/20/2023