Provider Demographics
NPI:1083884142
Name:LGR IMAGING, PC
Entity Type:Organization
Organization Name:LGR IMAGING, PC
Other - Org Name:PHYSICIANS IMAGING, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-677-4161
Mailing Address - Street 1:950A UNION RD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3481
Mailing Address - Country:US
Mailing Address - Phone:716-677-4162
Mailing Address - Fax:716-677-4163
Practice Address - Street 1:4154 SENECA STREET
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3053
Practice Address - Country:US
Practice Address - Phone:716-677-0500
Practice Address - Fax:716-677-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134789174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02271878Medicaid
000515012008OtherBLUE CROSS & BLUE SHIELD OF WNY
NY5607927OtherINDEPENDENT HEALTH
NY00030041901OtherUNIVERA
NY000515012006OtherBLUE CROSS & BLUE SHIED OF WNY
NY000515012007OtherBLUE CROSS & BLUE SHIELD OF WNY
NY02271878Medicaid