Healthcare Provider Details

I. General information

NPI: 1982931218
Provider Name (Legal Business Name): INTERPUBLIC MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 RICHMOND RD
STATEN ISLAND NY
10304-2413
US

IV. Provider business mailing address

PO BOX 520391
FLUSHING NY
11352-0391
US

V. Phone/Fax

Practice location:
  • Phone: 718-690-4237
  • Fax:
Mailing address:
  • Phone: 718-690-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number184001
License Number StateNY

VIII. Authorized Official

Name: LOURDES I PUBLICO
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 718-690-4237