Basic Information
| Provider Information | |||||||||
| NPI: | 1346325644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LADO | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 W 92ND ST | ||||||||
| Address2: | APT 7J | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100257444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176081881 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 611 NORTHERN BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110215207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163257000 | ||||||||
| FaxNumber: | 5163257001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 196511 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | 196511 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
| ID | Type | State | Issuer | Description | 2530734 | 01 | NY | US HEALTH - AETNA PIN | OTHER | BL4650935 | 01 | NY | DEA ID | OTHER | P2852741 | 01 | NY | OXFORD PIN | OTHER | 13-1740114 | 01 | NY | MMC TAX ID | OTHER | 30200 | 01 | NY | MONTE CMO | OTHER | 439N91 | 01 | NY | BLUE SHIELD PIN | OTHER | N65876 | 01 | NY | HEALTHNET-PHS PIN | OTHER | 0099245 | 01 | NY | CIGNA PIN | OTHER | 196511 | 01 | NY | NYS LICENSE | OTHER | P2456425 | 01 | NY | OXFORD PIN | OTHER | 02276882 | 05 | NY | MEDICAID | 10000021415 | 01 | NY | AFFINITY HEALTH PIN | OTHER | 196511-A14 | 01 | NY | HEALTH FIRST PIN | OTHER |