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General NPI Number Information
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NPI Number | 1083884142
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Entity Type | Organization
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Legal Business Name | LGR IMAGING, PC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 4154 SENECA STREET
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City | WEST SENECA
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State | NY
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Zip | 14224-3053
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Country | US
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Telephone | 716-677-0500
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Fax | 716-677-1800
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Provider Business Mailing Address
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Address Line | 950A UNION RD SUITE 424
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City | WEST SENECA
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State | NY
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Zip | 14224-3481
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Country | US
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Telephone | 716-677-4162
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Fax | 716-677-4163
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE G RAND
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Credential | MD
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Telephone | 716-677-4161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 134789
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License Number State | NY
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