| Lamd Medical Group And Multi Specialty | |
|
6506 Roosevelt Ave Woodside NY 11377-2928 | |
| (718) 639-3603 | |
| (718) 639-3605 |
| Full Name | Lamd Medical Group And Multi Specialty |
|---|---|
| Speciality | Clinic/Center |
| Location | 6506 Roosevelt Ave, Woodside, New York |
| Authorized Official Name and Position | Loren A. Martinez (GEN. OPERATIONAL MANAGER) |
| Authorized Official Contact | 7186393603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lamd Medical Group And Multi Specialty 6506 Roosevelt Ave Woodside NY 11377-2928 Ph: (718) 639-3603 | Lamd Medical Group And Multi Specialty 6506 Roosevelt Ave Woodside NY 11377-2928 Ph: (718) 639-3603 |
| NPI Number | 1992160758 |
|---|---|
| Provider Enumeration Date | 12/22/2015 |
| Last Update Date | 02/21/2022 |
| Medicare PECOS PAC ID | 8820371685 |
|---|---|
| Medicare Enrollment ID | O20170202000516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992160758 | NPI | - | NPPES |
| 33D1043979 | Other | NY | CLIA |
| 05593980 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 214048 (New York) | Secondary |
| Provider Name | Erie T Agustin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407892144 PECOS PAC ID: 5294639258 Enrollment ID: I20040726001151 |
| Provider Name | Johnny Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619906047 PECOS PAC ID: 8820018492 Enrollment ID: I20051128000570 |
| Provider Name | Israel Freeman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366401374 PECOS PAC ID: 3072667518 Enrollment ID: I20090818000158 |
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