Provider Demographics
NPI:1568556645
Name:NORTH STAR MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:NORTH STAR MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:LIPKA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH, MBA
Authorized Official - Phone:914-923-9415
Mailing Address - Street 1:14 CHURCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4831
Mailing Address - Country:US
Mailing Address - Phone:914-923-9405
Mailing Address - Fax:914-923-9412
Practice Address - Street 1:14 CHURCH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4831
Practice Address - Country:US
Practice Address - Phone:914-923-9415
Practice Address - Fax:914-923-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02957440Medicaid
NY02957440Medicaid