Provider Demographics
NPI:1396071528
Name:L.I.G. MEDICAL, P.C.
Entity type:Organization
Organization Name:L.I.G. MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-417-9081
Mailing Address - Street 1:480 2ND AVE
Mailing Address - Street 2:MAIN FLOOR SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9151
Mailing Address - Country:US
Mailing Address - Phone:347-417-9081
Mailing Address - Fax:718-732-2434
Practice Address - Street 1:480 2ND AVE
Practice Address - Street 2:MAIN FLOOR SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9151
Practice Address - Country:US
Practice Address - Phone:347-417-9081
Practice Address - Fax:718-732-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1427181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty