Provider Demographics
NPI:1689760787
Name:APPLE COUNTRY FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:APPLE COUNTRY FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-563-2526
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0978
Mailing Address - Country:US
Mailing Address - Phone:518-563-2526
Mailing Address - Fax:516-563-2721
Practice Address - Street 1:40 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3981
Practice Address - Country:US
Practice Address - Phone:518-563-2526
Practice Address - Fax:518-563-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1120Medicare ID - Type Unspecified