Provider Demographics
NPI:1487651410
Name:LAX, JAMES DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:LAX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 E 72ND ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4364
Mailing Address - Country:US
Mailing Address - Phone:212-988-5740
Mailing Address - Fax:212-988-0462
Practice Address - Street 1:160 E 72ND ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4364
Practice Address - Country:US
Practice Address - Phone:212-988-5740
Practice Address - Fax:212-988-0462
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY152612207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01341193Medicaid
NY01341193Medicaid
NY72D791Medicare PIN