Provider Demographics
NPI:1407285232
Name:LAKE ONTARIO PROMPT MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:LAKE ONTARIO PROMPT MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-216-6687
Mailing Address - Street 1:300 STATE ROUTE 104
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2956
Mailing Address - Country:US
Mailing Address - Phone:315-342-0030
Mailing Address - Fax:315-216-6669
Practice Address - Street 1:300 STATE ROUTE 104
Practice Address - Street 2:SUITE 2
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2956
Practice Address - Country:US
Practice Address - Phone:315-216-4036
Practice Address - Fax:315-216-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164385261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1003928953OtherNPI
NY3884939Medicaid