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Organization
INTERMED CARE PC
Active
Organization
INTERMED CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS MAZUROV MD (MEDICAL DIRECTOR)
(718) 331-9600
Entity
Organization
Contact information
Practice address
55 E 124TH ST, NEW YORK, NY 10035-1815
(646) 895-9118
Mailing address
1849 86TH ST, BROOKLYN, NY 11214-3108
(718) 331-9600
(718) 331-9703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03324018
—
NY
Enumeration date
08/22/2011
Last updated
09/16/2011
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