MEDICARE: CENTERPORT FAMILY MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	230512	NY

General Provider Information

NPI Number	:	1770582637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERPORT FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	2 SILLS CT
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1634
Country	:	US
Telephone Number	:	631-757-9500
Fax Number	:	631-757-2325

Provider Business Practice Location Address
First Line	:	2 SILLS CT
Second Line	:
City	:	CENTERPORT
State	:	NY
Zip	:	11721-1634
Country	:	US
Telephone Number	:	631-757-9500
Fax Number	:	631-757-2325

Authorized Official
Title or Position	:	PHYSICIAN/ DIRECTOR
Name	:	DR. LORRAINE FRANCES BURNS
Credential	:	M.D.
Telephone Number	:	631-757-9500

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/21/2007

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Directions to “CENTERPORT FAMILY MEDICINE ” Practice Location

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