NPIMap

Organization Active NPI

Island Medical of Medford, LLP

  • Family Medicine Physician
  • Medford, NY
National Provider Identifier
1316160658
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
143200 Issued in NY
Legal business name
ISLAND MEDICAL OF MEDFORD, LLP
Practice address
1647 Route 112
Medford, NY 11763-3635
Phone
(631) 758-2220
Fax
(631) 758-8355
NPI assigned
Apr 11, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Lissette Cepeda
Title
Office Manager
Phone
(631) 758-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 143200 NY Primary

Addresses

Primary practice location

1647 Route 112
Medford, NY 11763-3635

Mailing address

1647 Route 112
Medford, NY 11763-3635
Phone (631) 758-2220

National Provider Directory

National Provider Directory

Locations

1647 Route 112
Medford, NY 11763
Phone (631) 462-6644

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316160658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 ROUTE 112",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633635",
            "telephone_number": "631-758-2220",
            "fax_number": "631-758-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 ROUTE 112",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117633635",
            "telephone_number": "631-758-2220",
            "fax_number": "631-758-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND MEDICAL OF MEDFORD, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CEPEDA",
        "authorized_official_first_name": "LISSETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "631-758-2220"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "143200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.