1568556645 NPI number — NORTH STAR MEDICAL GROUP, P.C.

Table of content: (NPI 1568556645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568556645 NPI number — NORTH STAR MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR MEDICAL GROUP, P.C.
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:
1568556645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CHURCH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
OSSINING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10562-4831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-923-9405
Provider Business Mailing Address Fax Number:
914-923-9412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
OSSINING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10562-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-923-9415
Provider Business Practice Location Address Fax Number:
914-923-9412
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
DEE
Authorized Official Middle Name:
LIPKA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
914-923-9415

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02957440 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com