| Lindenwood Health Medical Pc | |
|
3974 Amboy Rd Suite 302 Staten Island NY 10308 | |
| (718) 967-1071 | |
| (718) 966-0359 |
| Full Name | Lindenwood Health Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 3974 Amboy Rd, Staten Island, New York |
| Authorized Official Name and Position | Tatyana Katsman (PRESIDENT) |
| Authorized Official Contact | 8622089959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lindenwood Health Medical Pc 3974 Amboy Rd Suite 302 Staten Island NY 10308 Ph: (718) 967-1071 | Lindenwood Health Medical Pc 3974 Amboy Rd Suite 302 Staten Island NY 10308 Ph: (718) 967-1071 |
| NPI Number | 1295274314 |
|---|---|
| Provider Enumeration Date | 02/22/2017 |
| Last Update Date | 06/28/2019 |
| Medicare PECOS PAC ID | 2567733629 |
|---|---|
| Medicare Enrollment ID | O20170808000958 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295274314 | NPI | - | NPPES |
| 05146507 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tatyana Katsman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447259841 PECOS PAC ID: 6305861345 Enrollment ID: I20180815001615 |
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