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General NPI Number Information
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NPI Number | 1205127669
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Entity Type | Organization
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Legal Business Name | TARGEE STREET INTERNAL MEDICINE GROUP
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 11 RALPH PL SUITE 317B
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4401
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Country | US
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Telephone | 718-447-4023
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Fax | 718-273-2025
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Provider Business Mailing Address
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Address Line | 11 RALPH PL SUITE 317B
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4401
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Country | US
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Telephone | 718-447-4023
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Fax | 718-273-2025
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Authorized Official
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Title or Position | OWNER
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Name | PAULINO V ALBANO
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Credential | MD
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Telephone | 718-447-4023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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