Provider Demographics
NPI:1962844126
Name:S B LAREN PHD PC
Entity Type:Organization
Organization Name:S B LAREN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:BLYTHE
Authorized Official - Last Name:LAREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-288-2763
Mailing Address - Street 1:20 E 68TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5844
Mailing Address - Country:US
Mailing Address - Phone:212-288-2763
Mailing Address - Fax:212-288-2763
Practice Address - Street 1:20 E 68TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5844
Practice Address - Country:US
Practice Address - Phone:212-288-2763
Practice Address - Fax:212-288-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013667261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center