Provider Demographics
NPI:1669489548
Name:KADISH, LAWRENCE JEROME (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JEROME
Last Name:KADISH
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 1:2 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6818
Mailing Address - Country:US
Mailing Address - Phone:914-472-9089
Mailing Address - Fax:914-472-9089
Practice Address - Street 1:2 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-6818
Practice Address - Country:US
Practice Address - Phone:914-472-9089
Practice Address - Fax:914-472-9089
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101635208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00642737Medicaid
644961Medicare ID - Type Unspecified
NY00642737Medicaid