Provider Demographics
NPI:1649209339
Name:NORTH COUNTRY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTH COUNTRY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-549-8181
Mailing Address - Street 1:195 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2921
Mailing Address - Country:US
Mailing Address - Phone:631-549-8181
Mailing Address - Fax:631-549-2028
Practice Address - Street 1:195 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2921
Practice Address - Country:US
Practice Address - Phone:631-549-8181
Practice Address - Fax:631-549-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W5T981Medicare ID - Type Unspecified