Provider Demographics
NPI:1770833816
Name:NORTH AREA MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:NORTH AREA MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-234-8982
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-234-8982
Mailing Address - Fax:315-235-8981
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-234-8982
Practice Address - Fax:315-235-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB8352Medicare UPIN