Healthcare Provider Details

I. General information

NPI: 1881950491
Provider Name (Legal Business Name): INTERBORO OB/GYN ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 TARGEE ST
STATEN ISLAND NY
10304-4300
US

IV. Provider business mailing address

1145 TARGEE ST
STATEN ISLAND NY
10304-4300
US

V. Phone/Fax

Practice location:
  • Phone: 718-668-3600
  • Fax: 718-987-9610
Mailing address:
  • Phone: 718-668-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number133084
License Number StateNY

VIII. Authorized Official

Name: MRS. MARIA INGARGIOLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-987-8787