Provider Demographics
NPI:1760695241
Name:FAMILY MEDICAL CARE ASSOCIATES,PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSHKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-234-8745
Mailing Address - Street 1:132 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-3603
Mailing Address - Country:US
Mailing Address - Phone:518-234-8745
Mailing Address - Fax:
Practice Address - Street 1:132 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-3603
Practice Address - Country:US
Practice Address - Phone:518-234-8745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0596OtherMEDICARE GROUP