1538260344 NPI number — NORTHERN RESPIRATORY SPECIALIST, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538260344 NPI number — NORTHERN RESPIRATORY SPECIALIST, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN RESPIRATORY SPECIALIST, PC
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:
Provider Other Organization Name Type Code:
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:
1538260344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
671 ROUTE 6
Provider Second Line Business Mailing Address:
NORTHERN RESPIRATORY SPECIALIST, PC
Provider Business Mailing Address City Name:
MAHOPAC
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10541-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-621-2007
Provider Business Mailing Address Fax Number:
845-621-4528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 CLARK PL
Provider Second Line Business Practice Location Address:
NORTHERN RESPIRATORY SPECIALIST PC
Provider Business Practice Location Address City Name:
MAHOPAC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10541-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-621-2211
Provider Business Practice Location Address Fax Number:
845-621-2046
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
RAJ
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-621-2211

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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