Provider Demographics
NPI:1770658627
Name:NORTH AUSTIN MEDICAL PC
Entity type:Organization
Organization Name:NORTH AUSTIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:POROGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD DO
Authorized Official - Phone:718-896-8502
Mailing Address - Street 1:6860 AUSTIN ST
Mailing Address - Street 2:2ND FLOOR, SUITE 209
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4220
Mailing Address - Country:US
Mailing Address - Phone:718-896-8502
Mailing Address - Fax:718-896-8502
Practice Address - Street 1:6860 AUSTIN ST
Practice Address - Street 2:2ND FLOOR, SUITE 209
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4220
Practice Address - Country:US
Practice Address - Phone:718-896-8502
Practice Address - Fax:718-896-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7122504OtherAETNA PPO
NYP3636754OtherOXFORD
NY01000614601OtherAMERICHOICE
NY114809283OtherGREAT WEST
NY5573BEQ231OtherEMPIRE
NY114809283OtherCONSUMER HEALTH NETWORK
NY8214337OtherQUAILCARE
NY0039357Medicaid
NY144809283OtherTHE EMPIRE
NY2539890OtherUNITED HEALTH PLAN
NY8994575OtherCIGNA
NYGHIOther8219337
NY3K6560OtherHEALTH NET
NY072248Medicare ID - Type Unspecified
NYP3636754OtherOXFORD