Provider Demographics
NPI:1841211836
Name:LAKESIDE ENT & ALLERGY LLC.
Entity Type:Organization
Organization Name:LAKESIDE ENT & ALLERGY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-8800
Mailing Address - Street 1:229 PARRISH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1791
Mailing Address - Country:US
Mailing Address - Phone:585-394-8800
Mailing Address - Fax:585-394-8800
Practice Address - Street 1:229 PARRISH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1795
Practice Address - Country:US
Practice Address - Phone:585-394-8800
Practice Address - Fax:585-394-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03463729Medicaid
NYAA1560Medicare PIN