Provider Demographics
NPI:1710992151
Name:RICHARD S AGUIRRE
Entity Type:Organization
Organization Name:RICHARD S AGUIRRE
Other - Org Name:LAKEVILLE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-346-4460
Mailing Address - Street 1:67 KENDALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9701
Mailing Address - Country:US
Mailing Address - Phone:315-462-9482
Mailing Address - Fax:315-462-5438
Practice Address - Street 1:5989 BIG TREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9719
Practice Address - Country:US
Practice Address - Phone:585-346-4460
Practice Address - Fax:585-346-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0033Medicare PIN