NPIMap

Organization Active NPI

Indianer, Lask & Rosenzweig, M.D.'S, Dermatology Group, a Medical Corp

  • Specialist
  • Encino, CA
National Provider Identifier
1487690475
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A35542 Issued in CA
Legal business name
INDIANER, LASK & ROSENZWEIG, M.D.'S, DERMATOLOGY GROUP, A MEDICAL CORP
Practice address
16260 Ventura Blvd Ste 530
Encino, CA 91436-2248
Phone
(818) 788-4022
Fax
(818) 788-3728
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gary Lask, M.D.NPI 1275567158
Title
Owner
Phone
(818) 788-4022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A35542 CA Primary

Addresses

Primary practice location

16260 Ventura Blvd Ste 530
Encino, CA 91436-2248

Mailing address

16260 Ventura Blvd Ste 530
Encino, CA 91436-2248
Phone (818) 788-4022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209001177 CA Part B Supplier - Clinic/Group Practice 4183518442 Receives reassigned benefits from 9 practitioners
Practice locations: Encino, CA

National Provider Directory

National Provider Directory

Locations

16260 Ventura Blvd
Ste 530
Encino, CA 91436
Phone (818) 788-4022

2001 Santa Monica Blvd
Ste 490W
Santa Monica, CA 90404
Phone (310) 359-6790

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1487690475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16260 VENTURA BLVD STE 530",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362248",
            "telephone_number": "818-788-4022",
            "fax_number": "818-788-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16260 VENTURA BLVD STE 530",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362248",
            "telephone_number": "818-788-4022",
            "fax_number": "818-788-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANER, LASK & ROSENZWEIG, M.D.'S, DERMATOLOGY GROUP, A MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "LASK",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-788-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A35542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.