Provider Demographics
NPI:1154429017
Name:NORTHEND MEDICAL PRACTICE PLLC
Entity type:Organization
Organization Name:NORTHEND MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-374-1014
Mailing Address - Street 1:1365 VAN ANTWERP RD
Mailing Address - Street 2:APT # E39
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4441
Mailing Address - Country:US
Mailing Address - Phone:518-374-1014
Mailing Address - Fax:518-374-1014
Practice Address - Street 1:1365 VAN ANTWERP RD
Practice Address - Street 2:APT # E39
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4441
Practice Address - Country:US
Practice Address - Phone:518-374-1014
Practice Address - Fax:518-374-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227718261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0390Medicare ID - Type Unspecified