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General NPI Number Information
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NPI Number | 1700478013
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MEDICAL CONCEPTS P.C.
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 11 E 47TH ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10017-1919
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Country | US
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Telephone | 212-355-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 BRIGHTON 5TH ST STE 1C
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City | BROOKLYN
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State | NY
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Zip | 11235-7003
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Country | US
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Telephone | 718-934-1920
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Fax | 718-934-2078
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. IGOR OSTROVSKY
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Credential | M.D.
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Telephone | 917-796-1267
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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 |
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License Number State |
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