Healthcare Provider Details

I. General information

NPI: 1407483399
Provider Name (Legal Business Name): INTERVENTIONAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 CONEY ISLAND AVE STE 101
BROOKLYN NY
11230-2367
US

IV. Provider business mailing address

10 E 8TH ST APT 3
NEW YORK NY
10003-5980
US

V. Phone/Fax

Practice location:
  • Phone: 917-536-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAN ZHANG
Title or Position: PARTNER
Credential:
Phone: 917-536-8500