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NPI Code Detail

MEDICARE: TRUE NORTH MEDICAL GROUP PC

MEDICARE: TRUE NORTH MEDICAL GROUP PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XS0106XOrthopaedic Hand Surgery Physician
2207XS0114XAdult Reconstructive Orthopaedic Surgery Physician
3207XS0117XOrthopaedic Surgery of the Spine Physician
4207XX0004XOrthopaedic Foot and Ankle Surgery Physician
5207XX0005XSports Medicine (Orthopaedic Surgery) Physician
62081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician
72084N0400XNeurology Physician
82085R0202XDiagnostic Radiology Physician
9208VP0000XPain Medicine Physician
10225100000XPhysical Therapist
11225X00000XOccupational Therapist
12363A00000XPhysician Assistant
13207X00000XOrthopaedic Surgery Physician

General Provider Information

NPI Number : 1013548999
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRUE NORTH MEDICAL GROUP PC
Provider Business Mailing Address
First Line : 444 MERRICK RD
Second Line :
City : LYNBROOK
State : NY
Zip : 11563-2460
Country : US
Telephone Number : 516-536-2800
Fax Number : 516-536-3947
Provider Business Practice Location Address
First Line : 3311 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-3611
Country : US
Telephone Number : 718-448-3210
Fax Number : 718-984-2642
Authorized Official
Title or Position : SENIOR VICE PRESIDENT & CFO
Name : MRS. MICHELE L CUSACK
Credential :
Telephone Number : 516-321-6058
Provider Enumeration Date : 01/30/2020
Last Update Date : 12/06/2022

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1902693807 — JENNA NICOLE DERLETH OT
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