Provider Demographics
NPI:1467485789
Name:THE FARMER'S MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:THE FARMER'S MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER-FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-698-3258
Mailing Address - Street 1:180 GRANNY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2130
Mailing Address - Country:US
Mailing Address - Phone:631-698-3258
Mailing Address - Fax:631-698-3259
Practice Address - Street 1:180 GRANNY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2130
Practice Address - Country:US
Practice Address - Phone:631-698-3258
Practice Address - Fax:631-698-3259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FARMER'S MEDICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221440173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEY001Medicare PIN
DE5657Medicare PIN
H59098Medicare UPIN
NYH52242Medicare UPIN