Provider Demographics
NPI:1710931837
Name:LANSINGBURGH FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:LANSINGBURGH FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETONA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ADETONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-235-8034
Mailing Address - Street 1:595 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-2501
Mailing Address - Country:US
Mailing Address - Phone:518-235-8034
Mailing Address - Fax:518-235-8036
Practice Address - Street 1:595 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2501
Practice Address - Country:US
Practice Address - Phone:518-235-8034
Practice Address - Fax:518-235-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2056621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0116Medicare ID - Type Unspecified