Provider Demographics
NPI:1689851115
Name:NORTH COUNTRY PRIMARY MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:NORTH COUNTRY PRIMARY MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-821-8911
Mailing Address - Street 1:43 RADIO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3125
Mailing Address - Country:US
Mailing Address - Phone:631-821-8911
Mailing Address - Fax:631-821-8912
Practice Address - Street 1:43 RADIO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3125
Practice Address - Country:US
Practice Address - Phone:631-821-8911
Practice Address - Fax:631-821-8912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY210655OtherNYS LICENSE
NY210655OtherNYS LICENSE