Healthcare Provider Details

I. General information

NPI: 1194027755
Provider Name (Legal Business Name): IG MEDICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W 204TH ST APT 1J
NEW YORK NY
10034-4011
US

IV. Provider business mailing address

570 W 204TH ST APT 1J
NEW YORK NY
10034-4011
US

V. Phone/Fax

Practice location:
  • Phone: 212-569-8070
  • Fax: 212-569-8071
Mailing address:
  • Phone: 212-569-8070
  • Fax: 212-569-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number236385
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number236385
License Number StateNY

VIII. Authorized Official

Name: DR. IGOR RYNDIN
Title or Position: UROLOGY
Credential: M.D
Phone: 212-569-8070