Provider Demographics
NPI:1346325644
Name:LADO, FRED A (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:A
Last Name:LADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 92ND ST
Mailing Address - Street 2:APT 7J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7444
Mailing Address - Country:US
Mailing Address - Phone:917-608-1881
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHERN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5207
Practice Address - Country:US
Practice Address - Phone:516-325-7000
Practice Address - Fax:516-325-7001
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1965112084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2530734OtherUS HEALTH - AETNA PIN
NYP2852741OtherOXFORD PIN
NY13-1740114OtherMMC TAX ID
NY30200OtherMONTE CMO
NY439N91OtherBLUE SHIELD PIN
NYN65876OtherHEALTHNET-PHS PIN
NY0099245OtherCIGNA PIN
NY196511OtherNYS LICENSE
NYP2456425OtherOXFORD PIN
NY02276882Medicaid
NY10000021415OtherAFFINITY HEALTH PIN
NY196511-A14OtherHEALTH FIRST PIN
NY196511-A14OtherHEALTH FIRST PIN
NYN65876OtherHEALTHNET-PHS PIN
NY43N91Medicare ID - Type UnspecifiedPROVIDER ID