Provider Demographics
NPI:1497893457
Name:LAKE SUCCESS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:LAKE SUCCESS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-8686
Mailing Address - Street 1:1300 UNION TURPIKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-354-8686
Mailing Address - Fax:516-328-8450
Practice Address - Street 1:1300 UNION TURPIKE
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-354-8686
Practice Address - Fax:516-328-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086286173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147571Medicare ID - Type Unspecified
NYB78693Medicare UPIN
NYD83478Medicare UPIN
NYB79733Medicare UPIN
NY654671Medicare ID - Type Unspecified
NYB11928Medicare UPIN
NY48C421Medicare ID - Type Unspecified
NY87A111Medicare ID - Type Unspecified
NYG88191Medicare UPIN
NY268171Medicare ID - Type Unspecified