Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X005507-1 | NY |
NPI | 1568892255 |
---|---|
Provider Name | Dr. Christopher Lorenzo Tice |
First Address | New Hyde Park, NY 11042-1120 |
Second Address | New Hyde Park, NY 11042-1120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 18/11/2013 |