Provider Demographics
NPI:1922018845
Name:LOWVILLE MEDICAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:LOWVILLE MEDICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PROVIDER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYNDAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-376-4600
Mailing Address - Street 1:5402 DAYAN ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1100
Mailing Address - Country:US
Mailing Address - Phone:315-376-4600
Mailing Address - Fax:315-376-5587
Practice Address - Street 1:5402 DAYAN ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1100
Practice Address - Country:US
Practice Address - Phone:315-376-4600
Practice Address - Fax:315-376-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X, 208000000X
NY013015-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02368225Medicaid
NY02368225Medicaid