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General NPI Number Information
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NPI Number | 1508013756
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Entity Type | Organization
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Legal Business Name | NORTH EASTERN NETWORK IPA
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 86 EAST 49TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11203
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Country | US
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Telephone | 718-807-4195
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Fax | 718-363-6879
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Provider Business Mailing Address
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Address Line | 86 EAST 49TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11203
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Country | US
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Telephone | 718-807-4195
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Fax | 718-363-6879
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. HENRY ROBERT PAUL
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Credential | MD
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Telephone | 914-953-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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