Provider Demographics
NPI:1700974169
Name:LARSEN, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 PARK AVE
Mailing Address - Street 2:C/O UPTOWN PEDIATRICS
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-427-0540
Mailing Address - Fax:212-534-1086
Practice Address - Street 1:1245 PARK AVE
Practice Address - Street 2:C/O UPTOWN PEDIATRICS
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-427-0540
Practice Address - Fax:212-534-1086
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY129356208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00686035Medicaid
NY00686035Medicaid