St Regis Mohawk Health Services | |
412 State Route 37 Akwesasne NY 13655-3109 | |
(518) 358-3141 | |
(518) 358-2797 |
Full Name | St Regis Mohawk Health Services |
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Speciality | Clinic/Center |
Location | 412 State Route 37, Akwesasne, New York |
Authorized Official Name and Position | Barbara Lazore (TRIBAL CHIEF) |
Authorized Official Contact | 5183583141 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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St Regis Mohawk Health Services 412 State Route 37 Akwesasne NY 13655-3109 Ph: (518) 358-3141 | St Regis Mohawk Health Services 412 State Route 37 Akwesasne NY 13655-3109 Ph: (518) 358-3141 |
NPI Number | 1457344558 |
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Provider Enumeration Date | 08/24/2005 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 5799748547 |
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Medicare Enrollment ID | O20041111000764 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457344558 | NPI | - | NPPES |
01178234 | Medicaid | NY | |
00651785 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 1653200R (New York) | Primary |
Provider Name | Jeffrey M Greenberg |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1902003205 PECOS PAC ID: 5799677191 Enrollment ID: I20040329001548 |
Provider Name | Gerald R Lauzon |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1588624720 PECOS PAC ID: 1850385444 Enrollment ID: I20040414001579 |
Provider Name | William R Latreille |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1508885716 PECOS PAC ID: 4284696170 Enrollment ID: I20041102001106 |
Provider Name | Robert J Wolff |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1972606234 PECOS PAC ID: 7911960794 Enrollment ID: I20041111000898 |
Provider Name | Mary R Mcgonagle |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528091436 PECOS PAC ID: 5890792873 Enrollment ID: I20061106000126 |
Provider Name | Stephanie Leffler |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336179365 PECOS PAC ID: 9436254927 Enrollment ID: I20070411000244 |
Provider Name | Debra A Meness |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538195433 PECOS PAC ID: 1153213574 Enrollment ID: I20101013000203 |
Provider Name | Wendy L Frank |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699087171 PECOS PAC ID: 7618149915 Enrollment ID: I20111011000013 |
Provider Name | Benson J Kelly |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1487614020 PECOS PAC ID: 2264337658 Enrollment ID: I20111219000202 |
Provider Name | Rita E Curran |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982042370 PECOS PAC ID: 9335383355 Enrollment ID: I20130913000003 |
Provider Name | Derek J Reynolds |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285074054 PECOS PAC ID: 4183851199 Enrollment ID: I20131219001442 |
Provider Name | Joseph E Robinson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508946443 PECOS PAC ID: 2466407549 Enrollment ID: I20160825002625 |
Provider Name | Mara A Bazdaric-russell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316245236 PECOS PAC ID: 0446539571 Enrollment ID: I20161114001442 |
Provider Name | Brandy Baillargeon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851743124 PECOS PAC ID: 7315227394 Enrollment ID: I20161208001765 |
Provider Name | Brian G Cole |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1184678955 PECOS PAC ID: 5496646655 Enrollment ID: I20170112001216 |
Provider Name | Song Y Park |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1225486947 PECOS PAC ID: 9739454117 Enrollment ID: I20171011001498 |
Provider Name | Heather M Pontius |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1093206732 PECOS PAC ID: 4284989963 Enrollment ID: I20180620003001 |
Provider Name | Mary M Herne |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730675190 PECOS PAC ID: 5092059725 Enrollment ID: I20181206000364 |
Provider Name | Daniel M Cahill |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1770658692 PECOS PAC ID: 1557669579 Enrollment ID: I20190325002613 |
Provider Name | Wahienhawi Hall |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1346500345 PECOS PAC ID: 6901228329 Enrollment ID: I20200611003064 |
Provider Name | Mary F Krawczewicz |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063955227 PECOS PAC ID: 0648519843 Enrollment ID: I20201218001342 |
Provider Name | Christine Venery |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1790849800 PECOS PAC ID: 6709009368 Enrollment ID: I20210105000082 |
Provider Name | Joseph S Park |
---|---|
Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1396736989 PECOS PAC ID: 6709106529 Enrollment ID: I20210716000442 |
Provider Name | Stefanie K Davis |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1922636992 PECOS PAC ID: 9335531615 Enrollment ID: I20220118002133 |
Provider Name | Lindsey N Hunter |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1225388234 PECOS PAC ID: 3779950431 Enrollment ID: I20221109001627 |
Provider Name | Samanthe A Caza |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750030672 PECOS PAC ID: 7719356047 Enrollment ID: I20221208002373 |
Provider Name | Zenas Kuate Defo |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1801479514 PECOS PAC ID: 9335518281 Enrollment ID: I20221215001067 |