LAKESHORE FAMILY MEDICINE ASSOCIATES PC (NPI# 1801211826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801211826 |
| Entity Type | Organization |
| Organization Name | LAKESHORE FAMILY MEDICINE ASSOCIATES PC |
| Other Organization Name | LAKESHORE FAMILY MEDICINE DERBY |
| Practice Address |
7060 Erie Rd Suite 100 Derby NY 14047-9430 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 7169470408 |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2014-02-27 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | 233142 | NY | Suppliers |
| Other Name | Type Code |
|---|---|
| Lakeshore Family Medicine Derby | Doing Business As Name - Organization |
| Street Address |
7060 ERIE RD SUITE 100 |
| City | DERBY |
| State | NY |
| Zip Code | 14047-9430 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799656 | Tariq A Sheikh | Family Medicine | 7060 Erie Rd, Suite 100, Derby, NY 14047-9430 | 2005-06-09 |
| 1962000307 | Miranda Braner | Nurse Practitioner | 7060 Erie Rd, Derby, NY 14047-9430 | 2020-10-16 |
| 1508305673 | Ashley Skipper | Physician Assistant | 7060 Erie Rd, Derby, NY 14047-9430 | 2017-02-22 |
| 1831589787 | Jennifer Hahn | Physical Therapist | 7060 Erie Rd, Derby, NY 14047-9430 | 2015-01-30 |
| 1558750679 | Jennifer Foley | Massage Therapist | 7060 Erie Rd, Derby, NY 14047-9430 | 2015-01-13 |
| 1518389238 | Eric Dibben | Physician Assistant | 7060 Erie Rd, Derby, NY 14047-9430 | 2014-01-15 |
| 1407129109 | Angel M Szkutak | Physician Assistant | 7060 Erie Rd, Derby, NY 14047-9430 | 2012-02-12 |
| 1568768604 | Dent Neurologic Institute | Clinic/Center | 7060 Erie Rd, Suite 500, Derby, NY 14047-9430 | 2011-02-08 |
| 1154647642 | Dent Neurologic Group, LLP | Clinical Neuropsychologist | 7060 Erie Rd, Derby, NY 14047-9430 | 2010-04-09 |
| 1770748246 | Donald Jordan Conrad | Chiropractor | 7060 Erie Rd, Suite 300, Derby, NY 14047-9416 | 2008-07-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225654494 | Brooks - Tlc Hospital System, Inc. | Rehabilitation, Substance Use Disorder Unit | 7020 Erie Road, Derby, NY 14047 | 2020-06-23 |
| 1114219607 | Frederick Eckles Jr. | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-05-03 |
| 1477887560 | Henna M Patel | Family Medicine | 7060 Erie Rd Suite 100, Derby, NY 14047 | 2009-09-23 |
| 1134300668 | Lisa M Bogner | Pharmacist | 3590 Union Rd, Cheektowaga, NY 14047 | 2007-11-27 |
| 1760546378 | James G Stengel | Internal Medicine | 1667 South Creek Rd, Derby, NY 14047 | 2006-12-20 |
| 1093888463 | Paul J Caro Md | Family Medicine | 7008 Erie Rd Rte 5, Suite A, Derby, NY 14047 | 2006-11-15 |
| 1417037755 | John M Mulawka IIi | Pediatrics | 6763 Erie Road Rt 5, Derby, NY 14047 | 2006-10-17 |
| 1720367782 | Michelle M Sirolli | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-08-09 |
| 1770862682 | Janet E Pajak | Licensed Practical Nurse | 6816 Erie Road, Derby, NY 14047 | 2011-08-09 |
| 1497828461 | Harmonia Collaborative Care Inc | Clinic/Center | 6722 Erie Rd, Derby, NY 14047 | 2006-11-16 |
| Find all providers in zip 14047 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1962041426 | B & R Wholesale, LLC | Non-Pharmacy Dispensing Site | 3858 Nostrand Ave Ste 203, Brooklyn, NY 11235-2038 | 2020-01-02 |
| 1508417221 | Eyeconic Vision Brownsville Inc | Non-Pharmacy Dispensing Site | 9617 Church Ave, Brooklyn, NY 11212-2443 | 2019-09-24 |
| 1588180343 | Incubizness, Inc. | Non-Pharmacy Dispensing Site | 717 Church St, Medina, NY 14103-1618 | 2017-08-14 |
| 1649722976 | Eyeconic Vision Group Inc | Non-Pharmacy Dispensing Site | 248 W 116th St, New York, NY 10026-2406 | 2016-11-03 |
| 1134585292 | Applied Sciences Edi Corp | Non-Pharmacy Dispensing Site | 3825 Bell Blvd, Bayside, NY 11361-3368 | 2016-01-05 |
| 1790168656 | Otc Mobile Stores | Non-Pharmacy Dispensing Site | 600 E 132nd St, Bronx, NY 10454-4639 | 2015-07-09 |
| 1235520271 | Allied Medical and Diagnostic Services, Dispensary | Non-Pharmacy Dispensing Site | 1410 Broadway, 23rd Floor, New York, NY 10018 | 2015-02-12 |
| 1083012348 | Add 2 Subtract LLC | Non-Pharmacy Dispensing Site | 22 Legendary Cir, Rye Brook, NY 10573-1077 | 2014-12-18 |
| 1912302233 | Performance Medical Services Pllc | Non-Pharmacy Dispensing Site | 70 E 55th St, 2nd Fl., New York, NY 10022-3222 | 2014-10-29 |
| 1346568730 | Hero Direct Inc | Non-Pharmacy Dispensing Site | 889 Waverly Ave, Holtsville, NY 11742-1109 | 2010-05-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.