Provider Demographics
NPI:1558539072
Name:5 TOWNS FAMILY MEDICAL CARE
Entity Type:Organization
Organization Name:5 TOWNS FAMILY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-371-5800
Mailing Address - Street 1:275A ROCKAWAY TPKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1232
Mailing Address - Country:US
Mailing Address - Phone:516-371-5800
Mailing Address - Fax:516-371-3712
Practice Address - Street 1:275A ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1232
Practice Address - Country:US
Practice Address - Phone:516-371-5800
Practice Address - Fax:516-371-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2108776Medicaid
NY082492Medicare PIN
NY2108776Medicaid