Provider Demographics
NPI:1790959302
Name:LAFEMINA, TINA MARIE (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:LAFEMINA
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:LAFEMINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPAC
Mailing Address - Street 1:270 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1823
Mailing Address - Country:US
Mailing Address - Phone:631-588-4442
Mailing Address - Fax:631-471-3039
Practice Address - Street 1:270 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1823
Practice Address - Country:US
Practice Address - Phone:631-588-4442
Practice Address - Fax:631-471-3039
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007845363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03299516Medicaid