Healthcare Provider Details

I. General information

NPI: 1396071528
Provider Name (Legal Business Name): L.I.G. MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 2ND AVE MAIN FLOOR SUITE
NEW YORK NY
10016-9151
US

IV. Provider business mailing address

480 2ND AVE MAIN FLOOR SUITE
NEW YORK NY
10016-9151
US

V. Phone/Fax

Practice location:
  • Phone: 347-417-9081
  • Fax: 718-732-2434
Mailing address:
  • Phone: 347-417-9081
  • Fax: 718-732-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1427181
License Number StateNY

VIII. Authorized Official

Name: ALAN R RAYMOND
Title or Position: OWNER
Credential: M.D.
Phone: 347-417-9081