Lauris J. Petersen MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

213320 Issued in NY

Legal business name

LAURIS J. PETERSEN MD PC

Doing business as

GLENRIDGE FAMILY MEDICINE

Practice address

15 Glenridge Rd
Glenville, NY 12302-4520

Phone

(518) 399-0909

Fax

(518) 399-2640

NPI assigned

Aug 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lauris Jon Petersen, MDNPI 1629152301

Title

Ceo/President

Phone

(518) 399-0909

Specialties & licenses 1

Addresses

Other names 1

• GLENRIDGE FAMILY MEDICINE Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Lauris J Petersen, MD

  • Family Medicine Physician
  • Glenville, NY
  • NPI 1629152301
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186704000000",
    "number": "1659563989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024520",
            "telephone_number": "518-399-0909",
            "fax_number": "518-399-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024520",
            "telephone_number": "518-399-0909",
            "fax_number": "518-399-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURIS J. PETERSEN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2007-08-10",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "LAURIS",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "518-399-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "213320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENRIDGE FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Gail Koklas, LMHC
• Andrea Marie Kufel, R.PH., PHARMD
• Mary Jeanne Lambeth
• Jean Anne Lange, RPH
• Steven Laplante
• Douglas Arthur Lavergne
• Helen Lawry, LAT, ATC
• Kelly Eileen Leaper
• Christine Lemp, LCSW
• Cynthia Ann Leschen, PT

• Family Medicine Physician in Glenville, NY
• Providers in Glenville, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; 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.