Provider Demographics
NPI:1902806458
Name:NORTHERN VALLEY PRIMARY CARE,P.C
Entity Type:Organization
Organization Name:NORTHERN VALLEY PRIMARY CARE,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YASMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORATHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-261-0999
Mailing Address - Street 1:44 W 21ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1221
Mailing Address - Country:US
Mailing Address - Phone:610-261-0999
Mailing Address - Fax:610-261-2187
Practice Address - Street 1:44 W 21ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1221
Practice Address - Country:US
Practice Address - Phone:610-261-0999
Practice Address - Fax:610-261-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013857207Q00000X
PA044704-L207R00000X
PA062722-L207R00000X
PAMA051873207R00000X
PAMD052173-L207R00000X
PAMA053534363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1124277603OtherNPI
PAOS013857OtherMD LIC
PAMD440485OtherMD LIC#
PA1275729873OtherMA053094
PA1366615213OtherNPI
PA0019326430003Medicaid
PA1447222070OtherNPI
PAOS013857OtherMD LIC
PA1366615213OtherNPI
PA0019326430003Medicaid
PA1275729873OtherMA053094