Lakeshore Family Medicine Assoc Pc | |
7060 Erie Rd Derby NY 14047-9306 | |
(716) 947-0408 | |
(716) 947-0413 |
Full Name | Lakeshore Family Medicine Assoc Pc |
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Speciality | Family Medicine |
Location | 7060 Erie Rd, Derby, New York |
Authorized Official Name and Position | Craig K Maclean (PRESIDENT) |
Authorized Official Contact | 7169474851 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lakeshore Family Medicine Assoc Pc 7060 Erie Rd Derby NY 14047-9306 Ph: (716) 947-0408 | Lakeshore Family Medicine Assoc Pc 7060 Erie Rd Derby NY 14047-9306 Ph: (716) 947-0408 |
NPI Number | 1295832418 |
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Provider Enumeration Date | 09/20/2006 |
Last Update Date | 07/30/2008 |
Medicare PECOS PAC ID | 8527031988 |
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Medicare Enrollment ID | O20040816000131 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295832418 | NPI | - | NPPES |
02288315 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 154802 (New York) | Primary |
Provider Name | Tariq A Sheikh |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891799656 PECOS PAC ID: 2961475314 Enrollment ID: I20040816000064 |
Provider Name | Henna Sheikh |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477887560 PECOS PAC ID: 6204974801 Enrollment ID: I20091118000429 |
Provider Name | Morris M Cavalieri |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1114921947 PECOS PAC ID: 2668659145 Enrollment ID: I20110609000483 |
Provider Name | Sarah E Scullion |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922624725 PECOS PAC ID: 7214356237 Enrollment ID: I20200924001903 |
Provider Name | Miranda Braner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1962000307 PECOS PAC ID: 2365857984 Enrollment ID: I20210212000459 |
Provider Name | Sunghoon Jung |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184209686 PECOS PAC ID: 2466851662 Enrollment ID: I20210520000108 |
Provider Name | Debbie Opoku |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720622046 PECOS PAC ID: 4486045937 Enrollment ID: I20211217000537 |
Caro Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7008 Erie Rd Rte 5, Suite A, Derby, NY 14047 Phone: 716-947-9147 Fax: 716-947-5175 | |
Harrity Optical Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6913 Erie Rd, Derby, NY 14047 Phone: 716-947-9992 |