Provider Demographics
NPI:1073708574
Name:INTERNATIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:MONTENEGRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-322-2688
Mailing Address - Street 1:9511 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2515
Mailing Address - Country:US
Mailing Address - Phone:718-322-2688
Mailing Address - Fax:
Practice Address - Street 1:8915 175TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5533
Practice Address - Country:US
Practice Address - Phone:718-739-4848
Practice Address - Fax:718-739-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227588302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05807OtherMEDICARE PROVIDER NUMBER