Healthcare Provider Details

I. General information

NPI: 1356160618
Provider Name (Legal Business Name): LIGHTHOUSE MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

IV. Provider business mailing address

144 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-5617
  • Fax:
Mailing address:
  • Phone: 631-730-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. TERI BILHARTZ
Title or Position: PRESIDENT
Credential: DO MPH
Phone: 631-707-5213