Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 203546 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 203546 | NY |
NPI | 1093923559 |
---|---|
Provider Name | Dr. David Laks |
First Address | New York, NY 10026-2494 |
Second Address | Briarwood, NY 11435-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02349099 | (05) | NY |
G79040 | (02) | NY |