Organization
LICH FACULTY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH HACKETT (ASSISTANT VICE PRESIDENT)
(212) 256-3424
Entity
Organization
Contact information
Practice address
339 HICKS ST, BROOKLYN, NY 11201-5509
(718) 780-1000
Mailing address
160 WATER ST, 20TH FLOOR, NEW YORK, NY 10038-4922
(212) 256-3424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/12/2007
Last updated
04/07/2008
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