Provider Demographics
NPI: | 1659883486 |
---|---|
Name: | TRUE NORTH MEDICAL GROUP PC |
Entity Type: | Organization |
Organization Name: | TRUE NORTH MEDICAL GROUP PC |
Other - Org Name: | NORTH SHORE-LIJ CARDIOVASCULAR MEDICINE PC |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MICHELE |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | CUSACK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 516-321-6058 |
Mailing Address - Street 1: | 972 BRUSH HOLLOW RD FL 5 |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTBURY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11590-1740 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 516-876-6065 |
Mailing Address - Fax: | 516-876-5572 |
Practice Address - Street 1: | 1728 SUNRISE HWY |
Practice Address - Street 2: | |
Practice Address - City: | MERRICK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11566-3745 |
Practice Address - Country: | US |
Practice Address - Phone: | 516-992-4700 |
Practice Address - Fax: | 516-992-4707 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-11-02 |
Last Update Date: | 2022-12-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |