Healthcare Provider Details

I. General information

NPI: 1063458560
Provider Name (Legal Business Name): I & R MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11241 QUEENS BLVD SUITE LLB
FOREST HILLS NY
11375-7475
US

IV. Provider business mailing address

9925 65TH RD
REGO PARK NY
11374-3654
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-7723
  • Fax: 718-520-7733
Mailing address:
  • Phone: 718-473-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number221146
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number214292
License Number StateNY

VIII. Authorized Official

Name: DR. ROZA ISRAEL
Title or Position: PARTNER
Credential: MD
Phone: 718-743-7090