Provider Demographics
NPI:1316087398
Name:LAFAYETTE MEDICAL, P.C.
Entity type:Organization
Organization Name:LAFAYETTE MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GASPARE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-928-2550
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:599 ROUTE 32
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5200
Mailing Address - Country:US
Mailing Address - Phone:845-928-2550
Mailing Address - Fax:
Practice Address - Street 1:599 ROUTE 32
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-5200
Practice Address - Country:US
Practice Address - Phone:845-928-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01100343Medicaid
NY01100343Medicaid