Provider Demographics
NPI:1710144340
Name:NORTHPORT FAMILY MEDICINE P.C
Entity Type:Organization
Organization Name:NORTHPORT FAMILY MEDICINE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-261-4445
Mailing Address - Street 1:325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1790
Mailing Address - Country:US
Mailing Address - Phone:631-261-4445
Mailing Address - Fax:631-261-3710
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1790
Practice Address - Country:US
Practice Address - Phone:631-261-4445
Practice Address - Fax:631-261-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00533248Medicaid
NY00590001Medicaid
NY02383080Medicaid
NY02089572Medicaid
NY03125188Medicaid
NY02089572Medicaid