LAKESIDE MEMORIAL HOSPITAL INC. (NPI# 1730392929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730392929 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEMORIAL HOSPITAL INC. |
| Other Organization Name | FAMILY WELLNESS CENTER |
| Practice Address |
80 West Ave Suite 209 Brockport NY 14420-1322 |
| Practice Telephone | 5856376044 |
| Practice Fax Number | 5856376053 |
| Mailing Telephone | 5856376044 |
| Mailing Fax Number | 5856376053 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2010-07-14 |
| Authorized Official Name | MICHAEL STAPLETON (CEO) |
| Authorized Official Telephone | 5853956095 |
| Is Organization Subpart | Y |
| Parent Organization Name | LAKESIDE MEMORIAL HOSPITAL INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00279543 | 05 | |
| NY | EXCELLUS-OUTPATIENT | 14005907 | 01 |
| NY | PREFERRED CARE | PC103050AX | 01 |
| Other Name | Type Code |
|---|---|
| Family Wellness Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740504141 | Lakeside Memorial Hospital Inc. | Specialist | 156 West Ave, Brockport, NY 14420-1229 | 2010-03-15 |
| 1316260623 | Lakeside Memorial Hospital Inc. | Orthopaedic Surgery | 156 West Ave, Brockport, NY 14420-1229 | 2010-03-02 |
| 1609109925 | Lakeside Memorial Hospital Inc. | Emergency Medicine | 156 West Ave, Brockport, NY 14420-1229 | 2009-09-18 |
| 1922144328 | Lakeside Memorial Hospital Inc. | Family Medicine | 8745 Lake Street Rd, Le Roy, NY 14482-9344 | 2007-01-30 |
| 1942359989 | Lakeside Memorial Hospital Inc. | General Practice | 156 West Ave, Brockport, NY 14420 | 2007-01-09 |
| 1972522670 | Lakeside Memorial Hospital Inc. | Specialist | 156 West Ave, Suite 104, Brockport, NY 14420-1229 | 2006-07-19 |
| 1639136153 | Lakeside Memorial Hospital Inc. | Clinic/Center | 156 West Ave, Brockport, NY 14420-1229 | 2006-04-27 |
| Street Address |
80 WEST AVE SUITE 209 |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043269335 | Pankaj Garg | Internal Medicine | 80 West Ave, Suite 109, Brockport, NY 14420-1322 | 2006-05-06 |
| 1083034854 | Metro Footcare Associates | Podiatrist | 80 West Ave, Brockport, NY 14420-1322 | 2014-04-21 |
| 1689848509 | Vinay R Aggarwal Md, Pllc | Clinic/Center | 80 West Ave, Suite 101, Brockport, NY 14420-1322 | 2008-04-22 |
| 1568481786 | Rajendra Mehta and Leena Mehta Physicians PC | Internal Medicine | 80 West Ave, Brockport, NY 14420-1322 | 2006-07-19 |
| 1821034695 | Syed Shah | Internal Medicine | 80 West Ave, Suite L-2, Brockport, NY 14420-1322 | 2006-06-21 |
| 1720021108 | Vinay Rajkumar Aggarwal | Emergency Medicine | 80 West Ave, Suite 101, Brockport, NY 14420-1322 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
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|---|---|---|---|---|
| 1225507114 | University Hospital At Stony Brook | General Acute Care Hospital | 740 County Road 39, Southampton, NY 11968-5090 | 2018-11-20 |
| 1184108144 | Samaritan Hospital of Troy, New York | General Acute Care Hospital | 500 Federal St Ste 602, Troy, NY 12180-2832 | 2018-09-17 |
| 1225559149 | Zulfa Omer | General Acute Care Hospital | 234 E 149th St Ste 20-8, Bronx, NY 10451-5504 | 2017-06-30 |
| 1992230171 | Ny Presbyterian-queens | General Acute Care Hospital | 85-88 Parsons Blvd., Jamaica, NY 11432 | 2017-04-26 |
| 1760916324 | Nayab Chowhan | General Acute Care Hospital | 818 Friel Pl, Brooklyn, NY 11218-2609 | 2017-04-20 |
| 1629509146 | Luke Alessi | General Acute Care Hospital | 207 Bayville Ave, Bayville, NY 11709-1652 | 2017-03-26 |
| 1376083378 | Department of Education | General Acute Care Hospital | 923 Elton Street, 2nd Floor, Brooklyn, NY 11208 | 2017-02-24 |
| 1255878492 | Winthrop University Hospital | General Acute Care Hospital | 212 Jericho Turnpike, Mineola, NY 11501 | 2017-01-26 |
| 1316480353 | Compassionate Companion Care, Pllc | General Acute Care Hospital | 204 Hendy Creek Rd, Pine City, NY 14871-9760 | 2016-11-23 |
| 1164964078 | Adrielle Ofosu | General Acute Care Hospital | 84 Kimball Ave, Yonkers, NY 10704-4222 | 2016-11-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.