Provider Demographics
NPI:1326442229
Name:NORTHEAST URGENT CARE MEDICAL ASSOCIATE
Entity Type:Organization
Organization Name:NORTHEAST URGENT CARE MEDICAL ASSOCIATE
Other - Org Name:MD URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUPOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-777-2273
Mailing Address - Street 1:388 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1465
Mailing Address - Country:US
Mailing Address - Phone:914-777-2273
Mailing Address - Fax:877-932-7426
Practice Address - Street 1:388 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1465
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:2014-10-21
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY616782100OtherDOL
NY261QU0200XOtherTAXON GROUP
NY6851910001OtherDMEPOS
NYA100077982OtherGROUP PTAN
NYA100077982Medicare PIN