Provider Demographics
NPI:1013029396
Name:LAGO, JESUS ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ANGEL
Last Name:LAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-1503
Mailing Address - Country:US
Mailing Address - Phone:914-882-6890
Mailing Address - Fax:
Practice Address - Street 1:558 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2815
Practice Address - Country:US
Practice Address - Phone:914-882-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1823552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF20093Medicare UPIN