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NPI Code Detail

MEDICARE: DR. JOSE MIGUEL LARES-GUIA MD

MEDICARE: DR. JOSE MIGUEL LARES-GUIA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician249492NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
203161662-03OTHERNYADAP
3249492OTHERNYMEDICAL LICENSE

General Provider Information

NPI Number : 1902030869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE MIGUEL LARES-GUIA MD
Provider Business Mailing Address
First Line : 111 WADSWORTH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10033-6102
Country : US
Telephone Number : 646-682-7544
Fax Number : 646-666-0339
Provider Business Practice Location Address
First Line : 111 WADSWORTH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10033-6102
Country : US
Telephone Number : 646-682-7544
Fax Number : 646-666-0339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2009
Last Update Date : 06/23/2026

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