Provider Demographics
NPI:1932232378
Name:PRIMARY HEALTH OF NORTHERN NEW YORK, PLLC
Entity Type:Organization
Organization Name:PRIMARY HEALTH OF NORTHERN NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ORIGINAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:THURHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-7550
Mailing Address - Street 1:156 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3602
Mailing Address - Country:US
Mailing Address - Phone:315-782-7550
Mailing Address - Fax:
Practice Address - Street 1:156 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3602
Practice Address - Country:US
Practice Address - Phone:315-782-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862091Medicaid
NYP00082023OtherPALMETTO RR MEDICARE
NY711552OtherMVP PROVIDER ID
NYDB0031OtherGRP # PALMETTO RR MCR
NY142658XXOtherPREFERRED CARE
NY5996936OtherGHI PROVIDER ID
NY5996936OtherGHI PROVIDER ID
NYDB0031OtherGRP # PALMETTO RR MCR
NYBA0066Medicare ID - Type UnspecifiedGROUP ID
NY01862091Medicaid
NYP00082023OtherPALMETTO RR MEDICARE