Basic Information
| Provider Information | |||||||||
| NPI: | 1205802493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGUS | ||||||||
| FirstName: | LAMBROS | ||||||||
| MiddleName: | D. GEORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1850 | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115511850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165726705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2201 HEMPSTEAD TPKE | ||||||||
| Address2: | 8TH FLOOR - PAVILLION | ||||||||
| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115541859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165726705 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 158918-1 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01244682 | 05 | NY | MEDICAID |