Vineyard Personalized Medicine LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

72590 Issued in MA

Legal business name

VINEYARD PERSONALIZED MEDICINE LLC

Practice address

24 Cournoyer Rd
West Tisbury, MA 02575

Phone

(508) 693-1300

Fax

(508) 693-1305

NPI assigned

May 31, 2012

Organization subpart

No

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

Authorized official

Name

Lisa Nagy, MDNPI 1770791030

Title

Sole Proprietor

Phone

(508) 693-1300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Environmental Health Center of Martha's Vineyard Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Lavine Nagy, M.D.

  • General Practice Physician
  • Vineyard Haven, MA
  • NPI 1770791030
  NPD (past) Authorized official

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448409600000",
    "number": "1275894875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 COURNOYER RD",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025687625",
            "telephone_number": "508-693-1300",
            "fax_number": "508-693-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 COURNOYER RD",
            "city": "WEST TISBURY",
            "state": "MA",
            "postal_code": "02575",
            "telephone_number": "508-693-1300",
            "fax_number": "508-693-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINEYARD PERSONALIZED MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2015-11-25",
        "status": "A",
        "authorized_official_last_name": "NAGY",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "508-693-1300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MA",
            "license": "72590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11009334A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Environmental Health Center of Martha's Vineyard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sander S Shapiro, M.D.
• Deborah Ann Shipkin, OT
• Carley Jordan Smith
• Emily Elizabeth Thanhauser
• Timothy W Tsai, M.D.
• Susan White, P.T.
• Polina Whitfield

• General Practice Physician in West Tisbury, MA
• Providers in West Tisbury, MA by specialty
• General Practice Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; 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.