Provider Demographics
NPI:1003182924
Name:NORTHEAST URGENT CARE MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NORTHEAST URGENT CARE MEDICAL ASSOCIATES, PLLC
Other - Org Name:MD URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-704-3356
Mailing Address - Street 1:1030 W BOSTON POST RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3328
Mailing Address - Country:US
Mailing Address - Phone:914-777-2273
Mailing Address - Fax:877-932-7426
Practice Address - Street 1:1030 W BOSTON POST RD
Practice Address - Street 2:SUITE A
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3328
Practice Address - Country:US
Practice Address - Phone:914-777-2273
Practice Address - Fax:877-932-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6851910001Medicare NSC