Provider Demographics
NPI:1679143820
Name:LOTUS MEDICAL MANAGEMENT, LLC
Entity type:Organization
Organization Name:LOTUS MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHYSICIAN PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINTERJANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPPM
Authorized Official - Phone:631-512-5500
Mailing Address - Street 1:1419 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-6213
Mailing Address - Country:US
Mailing Address - Phone:631-512-5500
Mailing Address - Fax:631-380-5305
Practice Address - Street 1:1419 DOLPHIN LN
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-6213
Practice Address - Country:US
Practice Address - Phone:631-512-5500
Practice Address - Fax:631-380-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization