Healthcare Provider Details

I. General information

NPI: 1376585778
Provider Name (Legal Business Name): ALLISON LAX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10021-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE SUITE 500
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2059
  • Fax: 212-746-8596
Mailing address:
  • Phone: 212-590-5152
  • Fax: 212-590-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number222397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: