Healthcare Provider Details

I. General information

NPI: 1306278791
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21422 73RD AVE
OAKLAND GARDENS NY
11364-2914
US

IV. Provider business mailing address

21422 73RD AVE
OAKLAND GARDENS NY
11364-2914
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-2960
  • Fax: 631-361-2966
Mailing address:
  • Phone: 718-464-4444
  • Fax: 718-347-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number217735
License Number State

VIII. Authorized Official

Name: RAJESH RAINA
Title or Position: OWNER
Credential: MD
Phone: 631-361-2960