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General NPI Number Information
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NPI Number | 1104124924
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Entity Type | Organization
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Legal Business Name | IG MEDICAL PC
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 570 W 204TH ST APT 1J
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City | NEW YORK
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State | NY
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Zip | 10034-4011
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Country | US
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Telephone | 212-569-8070
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Fax | 212-569-8071
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Provider Business Mailing Address
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Address Line | 570 W 204TH ST APT 1J
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City | NEW YORK
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State | NY
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Zip | 10034-4011
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Country | US
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Telephone | 212-569-8070
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Fax | 212-569-8071
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Authorized Official
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Title or Position | UROLOGY
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Name | IGOR RYNDIN
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Credential | MD
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Telephone | 212-569-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2363851
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License Number State | NY
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