Provider Demographics
NPI:1699148841
Name:LAG MD SERVICES INC
Entity type:Organization
Organization Name:LAG MD SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-6416
Mailing Address - Street 1:3048 BRIGHTON 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8080
Mailing Address - Country:US
Mailing Address - Phone:718-676-6416
Mailing Address - Fax:
Practice Address - Street 1:3048 BRIGHTON 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8080
Practice Address - Country:US
Practice Address - Phone:718-676-6416
Practice Address - Fax:718-942-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293D00000X293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory