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General NPI Number Information
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NPI Number | 1992160758
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Entity Type | Organization
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Legal Business Name | LAMD MEDICAL GROUP AND MULTISPECIALTY CORP
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6506 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-2928
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Country | US
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Telephone | 718-639-3603
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Fax | 718-639-3605
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Provider Business Mailing Address
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Address Line | 6506 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-2928
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Country | US
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Telephone | 718-639-3603
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Fax | 718-639-3605
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Authorized Official
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Title or Position | GEN. OPERATIONAL MANAGER
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Name | LOREN A. MARTINEZ
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Credential | PA
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Telephone | 718-639-3603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 214048
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License Number State | NY
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