Provider Demographics
NPI:1235309253
Name:JACOB LICHY M.D.&THOMAS KOLB M.D.P.C.
Entity type:Organization
Organization Name:JACOB LICHY M.D.&THOMAS KOLB M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-879-4488
Mailing Address - Street 1:222 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6001
Mailing Address - Country:US
Mailing Address - Phone:212-879-4488
Mailing Address - Fax:212-737-5917
Practice Address - Street 1:222 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6001
Practice Address - Country:US
Practice Address - Phone:212-879-4488
Practice Address - Fax:212-737-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122218-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08988Medicare UPIN