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General NPI Number Information
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NPI Number | 1093923559
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Entity Type | Individual
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Provider Name | DAVID LAKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 13876 QUEENS BLVD 1ST FLOOR
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City | BRIARWOOD
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State | NY
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Zip | 11435-2930
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Country | US
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Telephone | 718-850-6345
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Fax | 718-559-4895
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Provider Business Mailing Address
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Address Line | 214 W 116TH ST 1ST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10026-2494
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Country | US
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Telephone | 646-432-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 203546
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 203546
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License Number State | NY
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