Provider Demographics
NPI:1053364653
Name:NORTH STAR MEDICAL PC
Entity type:Organization
Organization Name:NORTH STAR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYNGERSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-943-0008
Mailing Address - Street 1:2615 E 16TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3805
Mailing Address - Country:US
Mailing Address - Phone:718-943-0008
Mailing Address - Fax:347-554-8464
Practice Address - Street 1:1408 OCEAN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3803
Practice Address - Country:US
Practice Address - Phone:718-943-0008
Practice Address - Fax:347-554-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52754207T00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWES291Medicare PIN