Healthcare Provider Details

I. General information

NPI: 1487196630
Provider Name (Legal Business Name): NORTHERN MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE STE 1117
CARMEL NY
10512-2454
US

IV. Provider business mailing address

159 BARNEGAT RD
POUGHKEEPSIE NY
12601-5454
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5136
  • Fax: 845-279-5168
Mailing address:
  • Phone: 845-592-4915
  • Fax: 845-592-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MADDIPOTI CHOUDRY
Title or Position: PRESIDENT
Credential: MD
Phone: 845-592-4915