NPIMap

Organization Active NPI

Patriot Family Medical Associates PLLC

  • Family Medicine Physician
  • Valley Stream, NY
National Provider Identifier
1811031776
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
212127 Issued in NY
Legal business name
PATRIOT FAMILY MEDICAL ASSOCIATES PLLC
Practice address
85 Roosevelt Ave
Valley Stream, NY 11581-1133
Phone
(516) 791-9500
Fax
(516) 791-9510
NPI assigned
Feb 16, 2007
Last updated
Jun 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Authorized official

Name
Mrs. Lori Wiley
Title
Office Manager
Phone
(516) 791-9500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 212127 NY Primary

Addresses

Primary practice location

85 Roosevelt Ave
Valley Stream, NY 11581-1133

Mailing address

85 Roosevelt Ave
Valley Stream, NY 11581-1133
Phone (516) 791-9500

National Provider Directory

National Provider Directory

Locations

85 Roosevelt Ave
Valley Stream, NY 11581
Phone (516) 791-9500

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1811031776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 ROOSEVELT AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811133",
            "telephone_number": "516-791-9500",
            "fax_number": "516-791-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 ROOSEVELT AVE",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811133",
            "telephone_number": "516-791-9500",
            "fax_number": "516-791-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT FAMILY MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "516-791-9500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "212127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.