NPIMap

Organization Active NPI

Peconic Family Medicine PC

  • Family Medicine Physician
  • Quogue, NY
National Provider Identifier
1720259914
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PECONIC FAMILY MEDICINE PC
Practice address
33 Montauk Hwy
Quogue, NY 11959-1555
Phone
(631) 653-6000
Fax
(631) 653-8310
NPI assigned
Mar 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Dr. Lewis Seth Anreder, M.D.NPI 1609982529
Title
President
Phone
(631) 653-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

33 Montauk Hwy
Quogue, NY 11959-1555

Mailing address

PO Box 1555
Quogue
New York, NY 11959-1555
Phone (631) 653-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120229000560 NY Part B Supplier - Clinic/Group Practice 0244121747 Receives reassigned benefits from 3 practitioners
Practice locations: Quogue, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1720259914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1555",
            "address_2": "QUOGUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "119591555",
            "telephone_number": "631-653-6000",
            "fax_number": "631-653-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MONTAUK HWY",
            "city": "QUOGUE",
            "state": "NY",
            "postal_code": "119591555",
            "telephone_number": "631-653-6000",
            "fax_number": "631-653-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECONIC FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "ANREDER",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "SETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-653-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.