Healthcare Provider Details

I. General information

NPI: 1518910207
Provider Name (Legal Business Name): NORTHSTAR MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 OCEAN AVE 3RD FLOOR
BROOKLYN NY
11230-3803
US

IV. Provider business mailing address

1408 OCEAN AVE 3RD FLOOR
BROOKLYN NY
11230-3803
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-0909
  • Fax: 718-258-4713
Mailing address:
  • Phone: 718-338-0909
  • Fax: 718-258-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number38812
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number38812
License Number StateNY

VIII. Authorized Official

Name: DR. PAUL ACKERMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-338-0909