| Lake Family Medical Practice Pc | |
|
201 Portion Rd Ste A Lake Ronkonkoma NY 11779-4172 | |
| (631) 981-1333 | |
| (631) 981-2326 |
| Full Name | Lake Family Medical Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 201 Portion Rd Ste A, Lake Ronkonkoma, New York |
| Authorized Official Name and Position | Robert A Tufano (CEO) |
| Authorized Official Contact | 6319811333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Family Medical Practice Pc 201 Portion Rd Ste A Lake Ronkonkoma NY 11779-4172 Ph: (631) 981-1333 | Lake Family Medical Practice Pc 201 Portion Rd Ste A Lake Ronkonkoma NY 11779-4172 Ph: (631) 981-1333 |
| NPI Number | 1639923675 |
|---|---|
| Provider Enumeration Date | 04/16/2024 |
| Last Update Date | 11/13/2024 |
| Medicare PECOS PAC ID | 9436684065 |
|---|---|
| Medicare Enrollment ID | O20241120000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639923675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert A Tufano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851442966 PECOS PAC ID: 4183884950 Enrollment ID: I20120402000518 |
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