Provider Demographics
NPI:1003037755
Name:KEGELES, LAWRENCE S, (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S,
Last Name:KEGELES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:127 W. 96TH ST.
Mailing Address - Street 2:APT. 13D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-543-5497
Mailing Address - Fax:212-568-6171
Practice Address - Street 1:1051 RIVERSIDE DRIVE
Practice Address - Street 2:UNIT 31
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-543-5497
Practice Address - Fax:212-568-6171
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY193253-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG14796Medicare UPIN
26M631Medicare ID - Type Unspecified