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General NPI Number Information
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NPI Number | 1356621445
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Entity Type | Organization
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Legal Business Name | INTERMED CARE PC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 55 E 124TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-1815
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Country | US
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Telephone | 646-895-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 1849 86TH ST
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City | BROOKLYN
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State | NY
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Zip | 11214-3108
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Country | US
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Telephone | 718-331-9600
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Fax | 718-331-9703
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BORIS MAZUROV
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Credential | MD
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Telephone | 718-331-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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