Provider Demographics
NPI:1871947895
Name:INTERNAL MEDICINE SPECIALIST OF NEW YORK P.C
Entity type:Organization
Organization Name:INTERNAL MEDICINE SPECIALIST OF NEW YORK P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MAIRAJ UD
Authorized Official - Middle Name:
Authorized Official - Last Name:DIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-633-6772
Mailing Address - Street 1:7 TALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2530
Mailing Address - Country:US
Mailing Address - Phone:516-633-6772
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-0100
Practice Address - Fax:631-719-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY236531OtherLICENSE