Provider Demographics
NPI:1972683647
Name:BAY FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:BAY FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-969-4590
Mailing Address - Street 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2734
Mailing Address - Country:US
Mailing Address - Phone:631-969-4590
Mailing Address - Fax:631-665-3928
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2734
Practice Address - Country:US
Practice Address - Phone:631-969-4590
Practice Address - Fax:631-665-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEJ051Medicare ID - Type Unspecified