Lisa Jean Mamakos, M.D.

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

282828 Issued in NY

Practice address

147 Beach Rd Ste a
Westhampton Beach, NY 11978

Phone

(631) 288-7746

Fax

(631) 288-7111

NPI assigned

Jul 13, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: lim4024@direct.nyp.org

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.

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  • Queens Village, NY
  • NPI 1316331168
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536537600000",
    "number": "1619265584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 BEACH RD STE A",
            "city": "WESTHAMPTON BEACH",
            "state": "NY",
            "postal_code": "119781733",
            "telephone_number": "631-288-7746",
            "fax_number": "631-288-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 BEACH RD STE A",
            "city": "WESTHAMPTON BEACH",
            "state": "NY",
            "postal_code": "11978",
            "telephone_number": "631-288-7746",
            "fax_number": "631-288-7111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "477 Cooper Road",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Westerville",
            "state": "OH",
            "postal_code": "43081",
            "country_code": "US",
            "telephone_number": "614-898-8714",
            "fax_number": "614-898-8842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAMAKOS",
        "first_name": "LISA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2018-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "282828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Joseph Leogrande, ATC
• Colette Marie Lettieri, LMSW
• Christopher David Liedke, DO
• Tracey Lutz, LMSW
• Kenneth John Malone Jr., DC
• Nicole Elizabeth Maresca
• Judith Margolis
• Ricardo Juan Martinez, LMT
• Mauro V. Dibenedetto DMD PC
• Theresa McCall, RN

• Geriatric Medicine (Family Medicine) Physician in Westhampton Beach, NY
• Providers in Westhampton Beach, NY by specialty
• Geriatric Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.