Provider Demographics
NPI:1972563070
Name:NORTH MEDICAL PC
Entity Type:Organization
Organization Name:NORTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEROLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-452-2000
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4868
Mailing Address - Country:US
Mailing Address - Phone:315-452-2501
Mailing Address - Fax:315-000-0000
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:(ONE OF 9 DBA'S FOR CORPORATION)
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2829
Practice Address - Fax:315-452-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207P00000X, 207Q00000X, 207V00000X, 207X00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1972563070OtherNPI CORPORATE NUMBER
NY0943650001Medicare NSC
NY39659AMedicare PIN