Healthcare Provider Details

I. General information

NPI: 1629069976
Provider Name (Legal Business Name): LGDK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 SAINT NICHOLAS AVE
NEW YORK NY
10031-4002
US

IV. Provider business mailing address

752 SAINT NICHOLAS AVE
NEW YORK NY
10031-4002
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-8300
  • Fax: 212-281-2500
Mailing address:
  • Phone: 212-281-8300
  • Fax: 212-281-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027351
License Number StateNY

VIII. Authorized Official

Name: LEB GERSHKOVICH
Title or Position: MEMBER LLC
Credential:
Phone: 212-281-8300