Individual provider Active NPI

Michael Daniel Lichtbroun, MD

  • Internal Medicine Physician
  • Valhalla, NY
National Provider Identifier
1780146118
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
318267 Issued in NY
Practice address
100 Woods Rd
Valhalla, NY 10595-1530
Phone
(914) 493-7000
NPI assigned
Apr 4, 2019
Last updated
Mar 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 318267 NY Primary
Hospitalist Physician 208M00000X 318267 NY

Addresses

Primary practice location

100 Woods Rd
Valhalla, NY 10595-1530

Mailing address

15 Redcoat Dr
East Brunswick, NJ 08816-2758
Phone (732) 390-7864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220929000119 NY Practitioner - Internal Medicine 7810373859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
318267NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Sep 19, 2022 Accepting new patients
Canton-Potsdam Hospital CurrentSince Sep 19, 2022 Accepting new patients

Locations

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1780146118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 REDCOAT DR",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088162758",
            "telephone_number": "732-390-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WOODS RD",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951530",
            "telephone_number": "914-493-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHTBROUN",
        "first_name": "MICHAEL",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-04",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "318267",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "318267",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valhalla, NY

Sources for this page

Verify at the official NPI Registry.