Peconic Bay Primary Medical Care

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PECONIC BAY PRIMARY MEDICAL CARE

Doing business as

Same

Practice address

13400 Main Rd
Mattituck, NY 11952-3209

Phone

(631) 298-4008

Fax

(631) 298-5969

NPI assigned

Feb 27, 2006

Last updated

May 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael O'Donnell

Title

Cfo

Phone

(631) 298-4479

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Same Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 125

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.

• David Angelillo

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1497959464
  Medicare reassignment Care Compare group NPD
• Roni Aoun, M.D.

  • Gastroenterology Physician
  • Riverhead, NY
  • NPI 1679147201
  Medicare reassignment Care Compare group NPD
• Christopher Blum, MD

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1659735686
  Medicare reassignment Care Compare group NPD
• Kimberly Britt, APRN

  • Family Nurse Practitioner
  • Southampton, NY
  • NPI 1245210178
  Medicare reassignment Care Compare group NPD
• Luigi Buono, DO

  • Family Medicine Physician
  • Mattituck, NY
  • NPI 1609816909
  Medicare reassignment Care Compare group NPD
• Cynthia Carlson, M.D.

  • Family Medicine Physician
  • Mattituck, NY
  • NPI 1760449615
  Medicare reassignment Care Compare group NPD
• Sara Ann Cerrone, M.D.

  • Gastroenterology Physician
  • Riverhead, NY
  • NPI 1043585276
  Medicare reassignment Care Compare group NPD
• Agostino Cervone, M.D.

  • Surgery Physician
  • Riverhead, NY
  • NPI 1841206018
  Medicare reassignment Care Compare group NPD
• Michael Robert Cespites Jr., DO

  • Sports Medicine (Family Medicine) Physician
  • Riverhead, NY
  • NPI 1598380735
  Medicare reassignment Care Compare group NPD
• Josephine Marie Champlin, DO

  • Family Medicine Physician
  • Center Moriches, NY
  • NPI 1851888770
  Medicare reassignment Care Compare group NPD
• Fang Chen, MD

  • Internal Medicine Physician
  • Manorville, NY
  • NPI 1255455689
  Medicare reassignment Care Compare group NPD
• Tanzia Afrin Chowdhury, D.O.

  • Family Medicine Physician
  • Riverhead, NY
  • NPI 1194111708
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1487620613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2377",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012108",
            "telephone_number": "631-298-4479",
            "fax_number": "631-591-3047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 MAIN RD",
            "city": "MATTITUCK",
            "state": "NY",
            "postal_code": "119523209",
            "telephone_number": "631-298-4008",
            "fax_number": "631-298-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECONIC BAY PRIMARY MEDICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "631-298-4479"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01714209",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Same",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Antoinette Plocek Notaro, M.D.
• Kristin Eileen Oliver, OTR
• Steven Orlowski
• Katie Owens, D.O.
• Carol Ann Payton, PMH-NP
• Bridget Leigh Petersen
• Joan Teresa Piscatello
• Amy Jeanne Prager, M.A., M. PHIL., SAS
• PS Consultants, Psychology & LMSW, PLLC
• Viola Quintero, M.S.W.

• Internal Medicine Physician in Mattituck, NY
• Providers in Mattituck, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.