Healthcare Provider Details

I. General information

NPI: 1568556645
Provider Name (Legal Business Name): NORTH STAR MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHURCH ST SUITE 208
OSSINING NY
10562-4831
US

IV. Provider business mailing address

14 CHURCH ST SUITE 200
OSSINING NY
10562-4831
US

V. Phone/Fax

Practice location:
  • Phone: 914-923-9415
  • Fax: 914-923-9412
Mailing address:
  • Phone: 914-923-9405
  • Fax: 914-923-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEE LIPKA JONES
Title or Position: CEO
Credential: RN, MPH, MBA
Phone: 914-923-9415