| Same | |
|
13400 Main Rd Mattituck NY 11952-3209 | |
| (631) 298-4008 | |
| (631) 298-5969 |
| Full Name | Same |
|---|---|
| Speciality | Internal Medicine |
| Location | 13400 Main Rd, Mattituck, New York |
| Authorized Official Name and Position | Michael O'donnell (CFO) |
| Authorized Official Contact | 6312984479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Same Po Box 2377 Riverhead NY 11901-2108 Ph: (631) 298-4479 | Same 13400 Main Rd Mattituck NY 11952-3209 Ph: (631) 298-4008 |
| NPI Number | 1487620613 |
|---|---|
| Provider Enumeration Date | 02/27/2006 |
| Last Update Date | 05/20/2024 |
| Medicare PECOS PAC ID | 7113817602 |
|---|---|
| Medicare Enrollment ID | O20040318000260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487620613 | NPI | - | NPPES |
| 01714209 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | John V Celentano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558445478 PECOS PAC ID: 7012808975 Enrollment ID: I20040322001133 |
| Provider Name | Evan C Nadal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619946548 PECOS PAC ID: 6103810544 Enrollment ID: I20040409000239 |
| Provider Name | Jennifer O Neill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326147703 PECOS PAC ID: 3779574363 Enrollment ID: I20040521000793 |
| Provider Name | David Prentiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407852940 PECOS PAC ID: 5890787980 Enrollment ID: I20040527000544 |
| Provider Name | Cynthia S Cichanowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194892224 PECOS PAC ID: 5597747253 Enrollment ID: I20040605000048 |
| Provider Name | Louis Romeo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1922049089 PECOS PAC ID: 7719960673 Enrollment ID: I20040610001568 |
| Provider Name | Luke G Allen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538172259 PECOS PAC ID: 7416931092 Enrollment ID: I20040614000738 |
| Provider Name | Brenda V Marcano Benfante |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821143603 PECOS PAC ID: 2860456217 Enrollment ID: I20041116000044 |
| Provider Name | Eric Shoenfeld |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902984115 PECOS PAC ID: 9335105634 Enrollment ID: I20041208000728 |
| Provider Name | Vincent J Leone |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1487667739 PECOS PAC ID: 2466410089 Enrollment ID: I20041229000770 |
| Provider Name | Michelle Tomasetti |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346271517 PECOS PAC ID: 0446218747 Enrollment ID: I20050103000326 |
| Provider Name | Agostino Cervone |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841206018 PECOS PAC ID: 3476591454 Enrollment ID: I20050421000514 |
| Provider Name | Daniel C Massiah |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1063485969 PECOS PAC ID: 1658315627 Enrollment ID: I20050610000855 |
| Provider Name | Steven P Marsala |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861409575 PECOS PAC ID: 8820002678 Enrollment ID: I20060131000766 |
| Provider Name | Andrea Wendland |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588674303 PECOS PAC ID: 1557376282 Enrollment ID: I20060216000069 |
| Provider Name | William a Lorusso |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1407962590 PECOS PAC ID: 4183639826 Enrollment ID: I20060216000084 |
| Provider Name | Nathalie B Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467571067 PECOS PAC ID: 3779592035 Enrollment ID: I20060413000527 |
| Provider Name | Brian K Mcnulty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528047271 PECOS PAC ID: 8022111640 Enrollment ID: I20070319000630 |
| Provider Name | Stephen P Ouzounian |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386615243 PECOS PAC ID: 5890886493 Enrollment ID: I20070811000021 |
| Provider Name | Brett E Ruffo |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1477758274 PECOS PAC ID: 5193817906 Enrollment ID: I20070824000457 |
| Provider Name | Fang C Chen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255455689 PECOS PAC ID: 2466541578 Enrollment ID: I20071127000570 |
| Provider Name | Blaise Napolitano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033318449 PECOS PAC ID: 0042309619 Enrollment ID: I20071204000770 |
| Provider Name | Luigi Buono |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609816909 PECOS PAC ID: 1456439660 Enrollment ID: I20080428000595 |
| Provider Name | Cynthia Carlson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760449615 PECOS PAC ID: 9032298161 Enrollment ID: I20080430000799 |
| Provider Name | Barbara J Farrell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043406424 PECOS PAC ID: 4486724804 Enrollment ID: I20080528000333 |
| Provider Name | Nirupa R Ramjisingh |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1053550533 PECOS PAC ID: 3173670064 Enrollment ID: I20090410000076 |
| Provider Name | Marc Puchir |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134132095 PECOS PAC ID: 7719029388 Enrollment ID: I20100120000105 |
| Provider Name | Steven Spiegel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275509424 PECOS PAC ID: 4981746997 Enrollment ID: I20100128000365 |
| Provider Name | Robert D Rubin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821282054 PECOS PAC ID: 9739223603 Enrollment ID: I20100216000139 |
| Provider Name | Michael Ciminiello |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1528272648 PECOS PAC ID: 7618000670 Enrollment ID: I20100728000870 |
| Provider Name | Barbara Joan Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437329158 PECOS PAC ID: 1153455332 Enrollment ID: I20100811000000 |
| Provider Name | Christine M O Donoghue-kitt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306039482 PECOS PAC ID: 2264614163 Enrollment ID: I20110315000107 |
| Provider Name | David Angelillo |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497959464 PECOS PAC ID: 7618150699 Enrollment ID: I20110329000646 |
| Provider Name | Denise F Dambrosia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558509828 PECOS PAC ID: 6901076496 Enrollment ID: I20110818000601 |
| Provider Name | Victor Bello |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356636468 PECOS PAC ID: 5294905378 Enrollment ID: I20110829000015 |
| Provider Name | Sandra M Wolf |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104086487 PECOS PAC ID: 1052588787 Enrollment ID: I20120120000837 |
| Provider Name | Amy B Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104158088 PECOS PAC ID: 3173790565 Enrollment ID: I20120126000228 |
| Provider Name | Guirlaine Blot-sanon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588818504 PECOS PAC ID: 0446417018 Enrollment ID: I20120209000291 |
| Provider Name | Patricia J Sondgeroth |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366615395 PECOS PAC ID: 3971767534 Enrollment ID: I20120611000418 |
| Provider Name | Ann B Morrill |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1952599821 PECOS PAC ID: 5597921429 Enrollment ID: I20120723000209 |
| Provider Name | Maureen Jean Ruga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255645347 PECOS PAC ID: 7618125279 Enrollment ID: I20120924000759 |
| Provider Name | Donna Hagon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508171646 PECOS PAC ID: 7618120478 Enrollment ID: I20130104000174 |
| Provider Name | James L Earl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780938373 PECOS PAC ID: 4789820127 Enrollment ID: I20130409000621 |
| Provider Name | Nicole P Gellert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316298532 PECOS PAC ID: 2769616085 Enrollment ID: I20130927000597 |
| Provider Name | Alphonso a Scotti |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1336160738 PECOS PAC ID: 2961403860 Enrollment ID: I20131231000030 |
| Provider Name | Rajeev B Patel |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1174769996 PECOS PAC ID: 9234368416 Enrollment ID: I20140211000373 |
| Provider Name | Danielle Faye Stoebe |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1033258009 PECOS PAC ID: 9830329051 Enrollment ID: I20140418000064 |
| Provider Name | Nazir a Lone |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1912053307 PECOS PAC ID: 4981831682 Enrollment ID: I20141020002472 |
| Provider Name | Elizabeth Sanders |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679981401 PECOS PAC ID: 4385962380 Enrollment ID: I20150422001540 |
| Provider Name | Christina Zaccara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760672992 PECOS PAC ID: 4082925821 Enrollment ID: I20150619000362 |
| Provider Name | Julie Vinod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861897621 PECOS PAC ID: 2062723638 Enrollment ID: I20150623002688 |
| Provider Name | Jessica M Petchonka |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1518360536 PECOS PAC ID: 3779894126 Enrollment ID: I20150625002111 |
| Provider Name | Jean Ann Swartz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043356744 PECOS PAC ID: 1951522655 Enrollment ID: I20151229001467 |
| Provider Name | Sara a Cerrone |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1043585276 PECOS PAC ID: 6901108885 Enrollment ID: I20160108002022 |
| Provider Name | Kimberly Muzzonigro |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386001725 PECOS PAC ID: 6204131451 Enrollment ID: I20160225001201 |
| Provider Name | Christine Barbaccia |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750748752 PECOS PAC ID: 0244529709 Enrollment ID: I20160523002076 |
| Provider Name | Joan Becht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568770238 PECOS PAC ID: 4880987973 Enrollment ID: I20160727001189 |
| Provider Name | Andrew Ribaudo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770574246 PECOS PAC ID: 6800183229 Enrollment ID: I20160928000522 |
| Provider Name | Jeffrey Tiu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962840207 PECOS PAC ID: 1456649763 Enrollment ID: I20161019000300 |
| Provider Name | Jillian E Saetta |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366715724 PECOS PAC ID: 7719148022 Enrollment ID: I20170208000263 |
| Provider Name | Michelle L Jack |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831631779 PECOS PAC ID: 9931483609 Enrollment ID: I20170223001723 |
| Provider Name | Denis J Nankervis |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1205111655 PECOS PAC ID: 5395017453 Enrollment ID: I20170824000333 |
| Provider Name | Darya Sterling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376958850 PECOS PAC ID: 4183997802 Enrollment ID: I20170831001531 |
| Provider Name | Victor Olujimi |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1104069160 PECOS PAC ID: 6507130085 Enrollment ID: I20170921002852 |
| Provider Name | Kyle Venturi |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1427579051 PECOS PAC ID: 2264706548 Enrollment ID: I20170926000940 |
| Provider Name | Kenneth R Mataragas |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003326133 PECOS PAC ID: 7911264783 Enrollment ID: I20171204000394 |
| Provider Name | Kristin S Gordon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215242326 PECOS PAC ID: 0840588562 Enrollment ID: I20180503002241 |
| Provider Name | Tanzia a Chowdhury |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194111708 PECOS PAC ID: 6709141070 Enrollment ID: I20180607002753 |
| Provider Name | Jaclyn a Farino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518486877 PECOS PAC ID: 8628324126 Enrollment ID: I20180712001914 |
| Provider Name | Michael Minjun Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891172722 PECOS PAC ID: 1254689276 Enrollment ID: I20180808001681 |
| Provider Name | Justin M Liu |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356837702 PECOS PAC ID: 8628327707 Enrollment ID: I20180822003239 |
| Provider Name | Guy-philippe Beauzile |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1528476082 PECOS PAC ID: 4082928155 Enrollment ID: I20181126001322 |
| Provider Name | Daniel M Shapiro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407324478 PECOS PAC ID: 6204173818 Enrollment ID: I20190121000434 |
| Provider Name | Nicole C Prianti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871853473 PECOS PAC ID: 9739421660 Enrollment ID: I20190425000651 |
| Provider Name | Janet L Baldasare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861512485 PECOS PAC ID: 3274876743 Enrollment ID: I20190524000794 |
| Provider Name | Kimberly Britt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245210178 PECOS PAC ID: 1951335363 Enrollment ID: I20190613001707 |
| Provider Name | James Smagala |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1083138754 PECOS PAC ID: 8022349315 Enrollment ID: I20191017002585 |
| Provider Name | Kevin Yeroushalmi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831552165 PECOS PAC ID: 2961741533 Enrollment ID: I20191112001575 |
| Provider Name | Kaitlin a Monteith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629611322 PECOS PAC ID: 1254767627 Enrollment ID: I20200203001014 |
| Provider Name | Kristen M Sochol |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1649697004 PECOS PAC ID: 7618205295 Enrollment ID: I20200710001754 |
| Provider Name | Valerie Lynn Cotsalas |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356500581 PECOS PAC ID: 6800219460 Enrollment ID: I20200715000752 |
| Provider Name | Cean Mahmud |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285165134 PECOS PAC ID: 2961748090 Enrollment ID: I20200911002596 |
| Provider Name | Lindsey Semprini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639529696 PECOS PAC ID: 5496092371 Enrollment ID: I20201113002648 |
| Provider Name | Olivia Demarco |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1962019760 PECOS PAC ID: 8921411190 Enrollment ID: I20210107000528 |
| Provider Name | Rohit Navlani |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1245693928 PECOS PAC ID: 4385927334 Enrollment ID: I20210527002847 |
| Provider Name | Christopher Blum |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1659735686 PECOS PAC ID: 9234539008 Enrollment ID: I20210616000373 |
| Provider Name | Josephine M Champlin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851888770 PECOS PAC ID: 8224382593 Enrollment ID: I20210715002559 |
| Provider Name | Amar Vyas |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1205323359 PECOS PAC ID: 3577817253 Enrollment ID: I20220819001664 |
| Provider Name | Kimberly Duffy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649731324 PECOS PAC ID: 2769866870 Enrollment ID: I20220908000941 |
| Provider Name | Kaitlyn Ross |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003499161 PECOS PAC ID: 4587040183 Enrollment ID: I20221005002310 |
| Provider Name | Kayla Schrage |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1295461002 PECOS PAC ID: 5294111597 Enrollment ID: I20221010001295 |
| Provider Name | Roland Ramkissoon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1134769920 PECOS PAC ID: 7517342561 Enrollment ID: I20221028000521 |
| Provider Name | Stephanie West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073247037 PECOS PAC ID: 5991172371 Enrollment ID: I20221028001180 |
| Provider Name | Roni Aoun |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1679147201 PECOS PAC ID: 5193193894 Enrollment ID: I20221201000280 |
| Provider Name | Lauren Sedlak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164792248 PECOS PAC ID: 9133599574 Enrollment ID: I20221230000112 |
| Provider Name | Danielle Sugar |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538883012 PECOS PAC ID: 7719352954 Enrollment ID: I20230331001208 |
| Provider Name | Amanda Rainey |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144935933 PECOS PAC ID: 6608241633 Enrollment ID: I20230405001427 |
| Provider Name | Devashree Parmar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831716109 PECOS PAC ID: 7315393857 Enrollment ID: I20231019002827 |
| Provider Name | Usman K Naqvi |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1225483092 PECOS PAC ID: 2860737079 Enrollment ID: I20240119002718 |
| Provider Name | Kasidy Smith |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1073396388 PECOS PAC ID: 8022461961 Enrollment ID: I20240127000105 |
| Provider Name | Dimple Varughese |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982167128 PECOS PAC ID: 4284177817 Enrollment ID: I20240624001302 |
| Provider Name | Michael R Cespites |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1598380735 PECOS PAC ID: 2860926763 Enrollment ID: I20241114003434 |
| Provider Name | Norman M Lee |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1144678228 PECOS PAC ID: 6103111471 Enrollment ID: I20241122001338 |
| Provider Name | Tamara Gorelik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174264097 PECOS PAC ID: 3274041850 Enrollment ID: I20250805000918 |
| Provider Name | Kevin Loeber |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326832387 PECOS PAC ID: 6103313606 Enrollment ID: I20251017000643 |
| Provider Name | Jasmin Maghsoudlou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588437057 PECOS PAC ID: 0648762609 Enrollment ID: I20251126000832 |
| Provider Name | Zoltan Kiss |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821884701 PECOS PAC ID: 5092208082 Enrollment ID: I20251208001986 |
Mattituck Family Medicine PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7555 Main Rd, Mattituck, NY 11952 Phone: 631-298-1678 Fax: 631-298-1679 |