Organization
INTERNATIONAL MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS AUGUSTO MONTENEGRO MD (CEO)
(718) 322-2688
Entity
Organization
Contact information
Practice address
8915 175TH ST, JAMAICA, NY 11432-5533
(718) 739-4848
(718) 739-2229
Mailing address
9511 99TH AVE, OZONE PARK, NY 11416-2515
(718) 322-2688
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
227588
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05807
MEDICARE PROVIDER NUMBER
NY
Enumeration date
09/08/2007
Last updated
09/08/2007
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