Provider Demographics
NPI:1275570418
Name:NORTHEAST MEDICAL CARE, PC
Entity Type:Organization
Organization Name:NORTHEAST MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NAKOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-997-0779
Mailing Address - Street 1:59 ROSEBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1627
Mailing Address - Country:US
Mailing Address - Phone:908-454-8600
Mailing Address - Fax:908-454-3524
Practice Address - Street 1:59 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1627
Practice Address - Country:US
Practice Address - Phone:908-454-8600
Practice Address - Fax:908-454-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDB3243OtherRRMEDICARE PIN
PADF8599OtherRRMEDICARE PIN
PA084069Medicare PIN
G42200Medicare UPIN
NJDB3243OtherRRMEDICARE PIN