Basic Information
| Provider Information | |||||||||
| NPI: | 1760894711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST UROLOGY RESEARCH | ||||||||
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| OtherOrganizationName: | DAVID U LIPSITZ, M.D. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 349 COPPERFIELD BLVD NE STE L | ||||||||
| Address2: | BOX 369 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048969830 | ||||||||
| FaxNumber: | 7048967815 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 VINEHAVEN DR NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047865131 | ||||||||
| FaxNumber: | 7047844129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | CAROLE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7048969830 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 9500640 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 8952130 | 05 | NC | MEDICAID |