Healthcare Provider Details

I. General information

NPI: 1891159240
Provider Name (Legal Business Name): LM MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 5TH AVE SUITE 1B
NEW YORK NY
10003-4377
US

IV. Provider business mailing address

33 5TH AVE SUITE 1B
NEW YORK NY
10003-4377
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-2272
  • Fax:
Mailing address:
  • Phone: 212-777-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number249977
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number277117
License Number StateNY

VIII. Authorized Official

Name: DR. MORGAN RABACH
Title or Position: DERMATOLOGY
Credential: MD
Phone: 203-687-5188