Provider Demographics
NPI:1679897060
Name:LICHTENSTEIN, JACQUELINE MARJORIE (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARJORIE
Last Name:LICHTENSTEIN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 MOTOR PARKWAY
Mailing Address - Street 2:SUITE LL8
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:833-547-7463
Mailing Address - Fax:631-248-5583
Practice Address - Street 1:340 HOWELLS RD STE 2B
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5322
Practice Address - Country:US
Practice Address - Phone:833-547-7463
Practice Address - Fax:631-318-9830
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2024-10-04
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Provider Licenses
StateLicense IDTaxonomies
NY019016363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical