Provider Demographics
NPI:1134323967
Name:DOWNTOWN INTEGRATED MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:DOWNTOWN INTEGRATED MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANZHELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORKINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-522-3399
Mailing Address - Street 1:81 WILLOUGHBY ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5291
Mailing Address - Country:US
Mailing Address - Phone:718-522-3399
Mailing Address - Fax:718-522-1888
Practice Address - Street 1:81 WILLOUGHBY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5291
Practice Address - Country:US
Practice Address - Phone:718-522-3399
Practice Address - Fax:718-522-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216866207Q00000X
NY206992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========GROUPOther1199 GROUP PROVIDER #