Provider Demographics
NPI:1063458560
Name:I & R MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:I & R MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:9925 65TH RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3654
Mailing Address - Country:US
Mailing Address - Phone:718-473-7090
Mailing Address - Fax:
Practice Address - Street 1:11241 QUEENS BLVD
Practice Address - Street 2:SUITE LLB
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7475
Practice Address - Country:US
Practice Address - Phone:718-520-7723
Practice Address - Fax:718-520-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221146207R00000X
NY214292208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07094Medicare PIN
H41924Medicare UPIN
H05498Medicare UPIN