Organization Active NPI

Jose Lares-Guia Physician PC

  • General Practice Physician
  • New York, NY
National Provider Identifier
1760816367
Registry record updated Mar 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
JOSE LARES-GUIA PHYSICIAN PC
Practice address
84 Grove St Apt 3
New York, NY 10014-3566
Phone
(646) 429-5555
Fax
(678) 553-1274
NPI assigned
Aug 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2024

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

Authorized official

Name
Dr. Jose M Lares-Guia, MD
Title
Sole Proprietor
Phone
(917) 613-6030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

84 Grove St Apt 3
New York, NY 10014-3566

Mailing address

84 Grove St Apt 3
New York, NY 10014-3566
Phone (646) 429-9555

Other identifiers 1

IdentifierTypeStateIssuer
03161662MedicaidNY

National Provider Directory

National Provider Directory

Locations

1123 Broadway
Ste 1017
New York, NY 10010
Phone (347) 696-7009

Practitioners & affiliated clinicians

Practitioners 1

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": "1377820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710547200000",
    "number": "1760816367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 GROVE ST APT 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100143566",
            "telephone_number": "646-429-9555",
            "fax_number": "646-429-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 GROVE ST APT 3",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100143566",
            "telephone_number": "646-429-5555",
            "fax_number": "678-553-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE LARES-GUIA PHYSICIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-30",
        "last_updated": "2024-03-16",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "LARES-GUIA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "917-613-6030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03161662",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.