NPIMap

Organization Active NPI

Internal Medicine at Lakeside

  • Internal Medicine Physician
  • Brockport, NY
National Provider Identifier
1083939722
Registry record updated Apr 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE AT LAKESIDE
Practice address
156 West Ave
Suite 106
Brockport, NY 14420-1229
Phone
(585) 395-6095
Fax
(585) 395-6084
NPI assigned
Apr 6, 2010
Last updated
Apr 6, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKESIDE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nancy M Wilson
Title
Physician Practices
Phone
(585) 395-6095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

156 West Ave
Suite 106
Brockport, NY 14420-1229

Mailing address

156 West Avenue
Suite 106
Brockport, NY 14420
Phone (585) 395-6095

National Provider Directory

National Provider Directory
Part of
Lakeside Memorial Hosp Inc

Locations

156 West Ave
Ste 106
Brockport, NY 14420
Phone (585) 637-2113

8745 Lake Street Rd
#1
Le Roy, NY 14482
Phone (585) 768-2620

21 Union Hill Dr
Ste B
Spencerport, NY 14559
Phone (585) 352-3535

Practitioners & affiliated clinicians

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 97

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270512000000",
    "number": "1083939722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 WEST AVENUE",
            "address_2": "SUITE 106",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "14420",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 WEST AVE",
            "address_2": "SUITE 106",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201229",
            "telephone_number": "585-395-6095",
            "fax_number": "585-395-6084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE AT LAKESIDE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESIDE MEMORIAL HOSPITAL",
        "enumeration_date": "2010-04-06",
        "last_updated": "2010-04-06",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "585-395-6095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.