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General NPI Number Information
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NPI Number | 1275877516
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Entity Type | Organization
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Legal Business Name | EVIDENCE BASED MEDICINE INC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 165 FROEHLICH FARM BLVD
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City | WOODBURY
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State | NY
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Zip | 11797-2906
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Country | US
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Telephone | 516-801-0170
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Fax | 845-230-6639
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | AUSTERLITZ
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State | NY
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Zip | 12017-0054
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Country | US
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Telephone | 518-392-2339
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Fax | 845-230-6639
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Authorized Official
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Title or Position | VP
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Name | DR. RON INNERFIELD
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Credential | M.D.
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Telephone | 518-392-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 118187
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License Number State | NY
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