Active NPI
Haverstraw Family Practice, P.C.
- Family Medicine Physician
- Haverstraw, NY
National Provider Identifier
1720177694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 208332
- Legal business name
- HAVERSTRAW FAMILY PRACTICE, P.C.
- Practice address
- 61 New Main St
Haverstraw, NY 10927-1813 - Phone
- (845) 942-4512
- Fax
- (845) 942-4514
- NPI assigned
- Oct 11, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jorge Ernesto Lugo, M.D.
- Title
- President
- Phone
- (845) 942-4512
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 208332 | NY | Primary |
Addresses
Primary practice location
61 New Main St
Haverstraw, NY 10927-1813
Mailing address
PO Box 380
61 New Main Street
Haverstraw, NY 10927-0380
Phone (845) 942-4512
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 396995 | Other | NY | CONNECTICARE |
| 46V621 | Other | NY | EMPIRE BC/BS |
| 01814819 | Medicaid | NY | |
| 172321P | Other | NY | HIP |
| 005720 | Other | NY | COMMUNITY CHOICE |
| 1000000194 | Other | NY | AFFINITY |
| 5997592 | Other | NY | GHI |
| 134973 | Other | NY | AETNA |
| 4C5847 | Other | NY | HEALTHNET |
| 040426012056 | Other | NY | FIDELIS |
| 221824 | Other | NY | WELLCARE |
| 393729 | Other | NY | MVP |
| P2543357 | Other | NY | OXFORD |
National Provider Directory
National Provider DirectoryLocations
61 New Main St
Haverstraw, NY 10927
Phone (845) 942-4512
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210118400000",
"number": "1720177694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 380",
"address_2": "61 NEW MAIN STREET",
"city": "HAVERSTRAW",
"state": "NY",
"postal_code": "109270380",
"telephone_number": "845-942-4512",
"fax_number": "845-942-4514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 NEW MAIN ST",
"city": "HAVERSTRAW",
"state": "NY",
"postal_code": "109271813",
"telephone_number": "845-942-4512",
"fax_number": "845-942-4514"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HAVERSTRAW FAMILY PRACTICE, P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-11",
"last_updated": "2008-05-07",
"status": "A",
"authorized_official_last_name": "LUGO",
"authorized_official_first_name": "JORGE",
"authorized_official_middle_name": "ERNESTO",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "845-942-4512",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NY",
"license": "208332",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "396995",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC/BS",
"identifier": "46V621",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01814819",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "172321P",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMUNITY CHOICE",
"identifier": "005720",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AFFINITY",
"identifier": "1000000194",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "5997592",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "134973",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "4C5847",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040426012056",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "221824",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "393729",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2543357",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Haverstraw, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.