1326442229 NPI number — NORTHEAST URGENT CARE MEDICAL ASSOCIATE

Table of content: (NPI 1326442229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326442229 NPI number — NORTHEAST URGENT CARE MEDICAL ASSOCIATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST URGENT CARE MEDICAL ASSOCIATE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MD URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326442229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
388 TARRYTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10607-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-777-2273
Provider Business Mailing Address Fax Number:
877-932-7426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 TARRYTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10607-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-777-2273
Provider Business Practice Location Address Fax Number:
877-932-7426
Provider Enumeration Date:
10/21/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUPOW
Authorized Official First Name:
JASON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
914-777-2273

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 616782100 . This is a "DOL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 261QU0200X . This is a "TAXON GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6851910001 . This is a "DMEPOS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A100077982 . This is a "GROUP PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".