Provider Demographics
NPI:1760894711
Name:NORTHEAST UROLOGY RESEARCH
Entity Type:Organization
Organization Name:NORTHEAST UROLOGY RESEARCH
Other - Org Name:DAVID U LIPSITZ, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-896-9830
Mailing Address - Street 1:349 COPPERFIELD BLVD NE STE L
Mailing Address - Street 2:BOX 369
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2432
Mailing Address - Country:US
Mailing Address - Phone:704-896-9830
Mailing Address - Fax:704-896-7815
Practice Address - Street 1:1084 VINEHAVEN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2438
Practice Address - Country:US
Practice Address - Phone:704-786-5131
Practice Address - Fax:704-784-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500640208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952130Medicaid
G09189Medicare UPIN
NC2215859AMedicare PIN