Provider Demographics
NPI:1578820783
Name:COMPLETE MEDICAL FAMILY CARE PLLC
Entity Type:Organization
Organization Name:COMPLETE MEDICAL FAMILY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:LEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-656-9200
Mailing Address - Street 1:735 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3211
Mailing Address - Country:US
Mailing Address - Phone:631-559-6869
Mailing Address - Fax:
Practice Address - Street 1:735 MIDDLE COUNTRY ROAD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3211
Practice Address - Country:US
Practice Address - Phone:631-656-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03057045Medicaid