LAKESIDE MEMORIAL HOSPITAL INC. (NPI# 1740504141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740504141 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEMORIAL HOSPITAL INC. |
| Other Organization Name | LAKESIDE UROLOGY |
| Practice Address |
156 West Ave Brockport NY 14420-1229 |
| Practice Telephone | 5853956095 |
| Mailing Telephone | 5853956095 |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2010-07-13 |
| Authorized Official Name | MS. STACEY SSHARE (BILLER) |
| Authorized Official Telephone | 5853956095 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | LAKESIDE MEMORIAL HOSPITAL INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Lakeside Urology | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1730392929 | Lakeside Memorial Hospital Inc. | General Acute Care Hospital | 80 West Ave, Suite 209, Brockport, NY 14420-1322 | 2007-05-07 |
| 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 |
156 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1229 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942271218 | Didem Miraloglu | Internal Medicine | 156 West Ave, Suite 106, Brockport, NY 14420-1229 | 2006-01-27 |
| 1679170849 | Kelsey Covel | Nurse Practitioner | 156 West Ave, Brockport, NY 14420-1229 | 2020-10-01 |
| 1720624562 | Geena Brady | Physical Therapist | 156 West Ave, Brockport, NY 14420-1229 | 2019-11-26 |
| 1801366380 | University Orthopaedic Associates of Rochester | Orthopaedic Surgery | 156 West Ave, Brockport, NY 14420-1229 | 2018-11-28 |
| 1508302159 | Melissa Kingston | Occupational Therapist | 156 West Ave, Brockport, NY 14420-1229 | 2017-01-06 |
| 1043769326 | Emma L Leatham | Physician Assistant | 156 West Ave, Brockport, NY 14420-1229 | 2016-09-27 |
| 1679811327 | Lakeside Health System | General Acute Care Hospital | 156 West Ave, Brockport, NY 14420-1229 | 2013-01-30 |
| 1801173448 | Lakeshore Surgical Practice, PC | Surgery | 156 West Ave, Brockport, NY 14420-1229 | 2011-11-10 |
| 1952613499 | Nathaniel James Wade | Pharmacist | 156 West Ave, Pharmacy Dept, Brockport, NY 14420-1229 | 2010-07-13 |
| 1235457375 | Suri Karthikeyan Mdpc | Internal Medicine | 156 West Ave, Suite 202, Brockport, NY 14420-1229 | 2010-05-13 |
| Find all providers in the same location | ||||
| 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 | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457737835 | Kelly Nauerth | Specialist | 211 Darla Dr, Brockport, NY 14420-9404 | 2015-08-07 |
| 1023352549 | Tvi Lehman Services | Specialist | 32 Mission Hill Dr, Brockport, NY 14420-1559 | 2012-11-21 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1659322063 | Lee James Cohen | Specialist | 350 New Campus Dr, Brockport, NY 14420-2997 | 2006-05-12 |
| 1497057624 | Cecil J Haggerty Jr Md PC | Specialist | 77 West Ave, Brockport, NY 14420-1305 | 2010-11-19 |
| 1629136809 | Michael Mark Militello | Specialist | 350 New Campus Dr, Brockport, NY 14420-2997 | 2006-12-04 |
| 1972522670 | Lakeside Memorial Hospital Inc. | Specialist | 156 West Ave, Suite 104, Brockport, NY 14420-1229 | 2006-07-19 |
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| 1891395463 | Mk Star Inc | Specialist | 104 Linwood Ave, Staten Island, NY 10305-4400 | 2020-10-31 |
| 1649870981 | David Abrahams | Specialist | 22016 138th Ave, Laurelton, NY 11413-2325 | 2020-10-27 |
| 1477152122 | Kevin D Spencer | Specialist | 12027 Nashville Blvd Apt 1, Saint Albans, NY 11412-3829 | 2020-10-23 |
| 1356940167 | Jacqueline Belinda Trichter | Specialist | 1400 Old Old Country Rd, Suite C103n, Westbury, NY 11590 | 2020-10-22 |
| 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.