Provider Demographics
NPI:1235226754
Name:WESTBURY FAMILY MEDICAL
Entity Type:Organization
Organization Name:WESTBURY FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:VANEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-333-9833
Mailing Address - Street 1:530 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4500
Mailing Address - Country:US
Mailing Address - Phone:516-333-9833
Mailing Address - Fax:516-333-9836
Practice Address - Street 1:530 OLD COUNTRY RD
Practice Address - Street 2:2A
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4500
Practice Address - Country:US
Practice Address - Phone:516-333-9833
Practice Address - Fax:516-333-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190283-2207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02576630Medicaid
NY02576630Medicaid