Provider Demographics
NPI:1285355248
Name:NORTHEAST FAMILY MEDICAL PLLC
Entity type:Organization
Organization Name:NORTHEAST FAMILY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-554-6477
Mailing Address - Street 1:138 MAIN ST # 1009
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1702
Mailing Address - Country:US
Mailing Address - Phone:516-554-6477
Mailing Address - Fax:347-889-5915
Practice Address - Street 1:667 61ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4123
Practice Address - Country:US
Practice Address - Phone:516-554-6477
Practice Address - Fax:347-889-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty