Healthcare Provider Details

I. General information

NPI: 1497893457
Provider Name (Legal Business Name): LAKE SUCCESS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 UNION TURPIKE SUITE 301
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

1300 UNION TURPIKE SUITE 301
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-8686
  • Fax: 516-328-8450
Mailing address:
  • Phone: 516-354-8686
  • Fax: 516-328-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number086286
License Number StateNY

VIII. Authorized Official

Name: DR. GERALD E SCHATTNER
Title or Position: DOCTOR
Credential: MD
Phone: 516-354-8686