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General NPI Number Information
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NPI Number | 1235481383
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL MEDICAL P.C.
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 1575 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-7203
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Country | US
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Telephone | 718-339-7500
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Fax | 646-961-4768
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Provider Business Mailing Address
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Address Line | 1575 E 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11230-7203
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Country | US
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Telephone | 718-339-7500
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Fax | 646-961-4768
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | DR. BILLY HANS FORD
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Credential | M.D.
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Telephone | 718-339-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 182920
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License Number State | NY
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