Provider Demographics
NPI:1538575857
Name:THE LAKE MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:THE LAKE MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESORMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-509-5836
Mailing Address - Street 1:171 LAKE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3947
Mailing Address - Country:US
Mailing Address - Phone:914-509-5836
Mailing Address - Fax:914-357-2489
Practice Address - Street 1:171 LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3947
Practice Address - Country:US
Practice Address - Phone:914-509-5836
Practice Address - Fax:914-357-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250020261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty