| Peconic Family Medicine Pc | |
|
33 Montauk Hwy Quogue NY 11959-1555 | |
| (631) 653-6000 | |
| (631) 653-8310 |
| Full Name | Peconic Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 33 Montauk Hwy, Quogue, New York |
| Authorized Official Name and Position | Lewis Seth Anreder (PRESIDENT) |
| Authorized Official Contact | 6316536000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peconic Family Medicine Pc Po Box 1555 Quogue New York NY 11959-1555 Ph: (631) 653-6000 | Peconic Family Medicine Pc 33 Montauk Hwy Quogue NY 11959-1555 Ph: (631) 653-6000 |
| NPI Number | 1720259914 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 05/05/2022 |
| Medicare PECOS PAC ID | 0244121747 |
|---|---|
| Medicare Enrollment ID | O20120229000560 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720259914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lewis S Anreder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609982529 PECOS PAC ID: 3274791793 Enrollment ID: I20120229000631 |
| Provider Name | Lori Roughton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649514597 PECOS PAC ID: 1254638125 Enrollment ID: I20160322000114 |
| Provider Name | Maryta J Marzano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306499637 PECOS PAC ID: 4385051796 Enrollment ID: I20210401000333 |