Provider Demographics
NPI:1447850425
Name:LIDOWITZ, MICHAEL EDWARD JR (LPN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:LIDOWITZ
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2528
Mailing Address - Country:US
Mailing Address - Phone:631-626-9713
Mailing Address - Fax:
Practice Address - Street 1:250 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2528
Practice Address - Country:US
Practice Address - Phone:631-626-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332241-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse