Healthcare Provider Details

I. General information

NPI: 1316087398
Provider Name (Legal Business Name): LAFAYETTE MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

IV. Provider business mailing address

PO BOX 429 599 ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

V. Phone/Fax

Practice location:
  • Phone: 845-928-2550
  • Fax:
Mailing address:
  • Phone: 845-928-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number157672
License Number StateNY

VIII. Authorized Official

Name: DR. GASPARE A. POLIZZI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-928-2550