Healthcare Provider Details

I. General information

NPI: 1598052557
Provider Name (Legal Business Name): JOHN HARRY LAGONIKOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HAMILTON AVE
TRENTON NJ
08629-1915
US

IV. Provider business mailing address

601 HAMILTON AVE
TRENTON NJ
08629-1915
US

V. Phone/Fax

Practice location:
  • Phone: 609-599-5061
  • Fax:
Mailing address:
  • Phone: 609-599-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number267142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: