Provider Demographics
NPI:1427120112
Name:LECHTENBERG, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LECHTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ATLANTIC AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6753
Mailing Address - Country:US
Mailing Address - Phone:718-625-2004
Mailing Address - Fax:718-246-2566
Practice Address - Street 1:100 ATLANTIC AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6753
Practice Address - Country:US
Practice Address - Phone:718-625-2004
Practice Address - Fax:718-246-2566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1233352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00231961Medicaid
NY316161Medicare PIN
NYB12808Medicare UPIN