Provider Demographics
NPI:1417119538
Name:LEXINGTON MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:LEXINGTON MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LIAKEAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-750-5088
Mailing Address - Street 1:139 E 57TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2102
Mailing Address - Country:US
Mailing Address - Phone:212-750-5088
Mailing Address - Fax:212-750-6118
Practice Address - Street 1:139 E 57TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2102
Practice Address - Country:US
Practice Address - Phone:212-750-5088
Practice Address - Fax:212-750-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH77596Medicare UPIN