Roxane Lacy, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

225654-1 Issued in NY

Practice address

45 W Suffolk Ave FL 2
Central Islip, NY 11722-2156

Phone

(631) 582-4858

Fax

(631) 582-4881

NPI assigned

Jan 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IBCFAA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Godwin Medical PC

  • Primary Care Clinic/Center
  • Bronx, NY
  • NPI 1679749808
  NPD (past)
• Suffolk Medical PC

  • Family Medicine Physician
  • Central Islip, NY
  • NPI 1588094288
  NPD (past)
• Suffolk Pediatric, PC

  • Pediatrics Physician
  • Central Islip, NY
  • NPI 1427355775
  NPD (past)

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

{
    "created_epoch": "1168732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362096000000",
    "number": "1457402802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 W SUFFOLK AVE FL 2",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222156",
            "telephone_number": "631-582-4858",
            "fax_number": "631-582-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 W SUFFOLK AVE FL 2",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222156",
            "telephone_number": "631-582-4858",
            "fax_number": "631-582-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "ROXANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-14",
        "last_updated": "2013-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225654-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02554745",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Paul Krumholz, D.C.
• Kelsey Rose Krumholz
• Maria Kurth
• Claudette Marx Lacast, LPN
• Marge Lacoste-Langston
• John David Lance, LMT
• Emilie Ann Larson, LMSW
• Catherine Laureano, RN
• Sonia H Lawson
• Marcia Amoy Ledwidge

• Pediatrics Physician in Central Islip, NY
• Providers in Central Islip, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; 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.