1669717450 NPI number — NEW MILLENNIUM LAPAROSCOPY, P.C.

Table of content: DR. SIRAK LAGOS LEMMA M.D. (NPI 1255403523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669717450 NPI number — NEW MILLENNIUM LAPAROSCOPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MILLENNIUM LAPAROSCOPY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669717450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3984 WASHINGTON BLVD
Provider Second Line Business Mailing Address:
#344
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94538-4954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-926-6521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 ESTUDILLO AVE
Provider Second Line Business Practice Location Address:
#209
Provider Business Practice Location Address City Name:
SAN LEANDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94577-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-926-6521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-926-6521

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G88950 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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