Provider Demographics
NPI:1538260344
Name:NORTHERN RESPIRATORY SPECIALIST, PC
Entity type:Organization
Organization Name:NORTHERN RESPIRATORY SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-621-2211
Mailing Address - Street 1:671 ROUTE 6
Mailing Address - Street 2:NORTHERN RESPIRATORY SPECIALIST, PC
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1638
Mailing Address - Country:US
Mailing Address - Phone:845-621-2007
Mailing Address - Fax:845-621-4528
Practice Address - Street 1:21 CLARK PL
Practice Address - Street 2:NORTHERN RESPIRATORY SPECIALIST PC
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4723
Practice Address - Country:US
Practice Address - Phone:845-621-2211
Practice Address - Fax:845-621-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W1L731Medicare ID - Type Unspecified
W1L732Medicare ID - Type Unspecified