Provider Demographics
NPI:1255968335
Name:NORTHERN GENERAL MEDICAL PRACTICE, P.C.
Entity type:Organization
Organization Name:NORTHERN GENERAL MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-716-1088
Mailing Address - Street 1:185 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5640
Mailing Address - Country:US
Mailing Address - Phone:917-837-4210
Mailing Address - Fax:
Practice Address - Street 1:10520 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1133
Practice Address - Country:US
Practice Address - Phone:347-848-0357
Practice Address - Fax:347-848-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty