Provider Demographics
NPI:1912134826
Name:FAMILY MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOKETCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-354-0510
Mailing Address - Street 1:11 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3559
Mailing Address - Country:US
Mailing Address - Phone:845-354-0510
Mailing Address - Fax:845-354-0629
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-354-0510
Practice Address - Fax:845-354-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001850Medicare PIN