Healthcare Provider Details

I. General information

NPI: 1821167453
Provider Name (Legal Business Name): PATRICK G. NORTHUP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E 34TH ST FL 8
NEW YORK NY
10016-4910
US

IV. Provider business mailing address

14 WALL ST FL 9
NEW YORK NY
10005-2178
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8134
  • Fax: 212-263-8157
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA11514400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number315458
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number25MA11514400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number315458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: