Provider Demographics
NPI:1063471779
Name:NORTH STAR EMERGENCY PHYSICIANS, PC
Entity Type:Organization
Organization Name:NORTH STAR EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEZEZON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:315-265-1120
Mailing Address - Street 1:20 COTTAGE ST
Mailing Address - Street 2:RM 211
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2800
Mailing Address - Country:US
Mailing Address - Phone:315-265-1120
Mailing Address - Fax:315-265-1121
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-265-1120
Practice Address - Fax:315-265-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN
NY=========OtherTIN