Provider Demographics
NPI:1588779979
Name:HAUSMAN, LIONEL GLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:GLEN
Last Name:HAUSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:247 3RD AVE RM L3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7453
Mailing Address - Country:US
Mailing Address - Phone:212-532-2220
Mailing Address - Fax:212-213-5735
Practice Address - Street 1:247 3RD AVE RM L3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7453
Practice Address - Country:US
Practice Address - Phone:212-532-2220
Practice Address - Fax:212-213-5735
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004745-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01243838Medicaid
NY01243838Medicaid
NYU17783Medicare UPIN