Healthcare Provider Details

I. General information

NPI: 1881604197
Provider Name (Legal Business Name): MANUEL LAGMAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

203 BENEDICT AVE
STATEN ISLAND NY
10314-2371
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-4408
  • Fax: 718-616-4105
Mailing address:
  • Phone: 718-448-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number107296-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: