Provider Demographics
NPI:1144235516
Name:INTERMED CARE PC
Entity Type:Organization
Organization Name:INTERMED CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-368-1170
Mailing Address - Street 1:1849 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3108
Mailing Address - Country:US
Mailing Address - Phone:718-331-9600
Mailing Address - Fax:718-331-9703
Practice Address - Street 1:3048 BRIGHTON 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8080
Practice Address - Country:US
Practice Address - Phone:718-368-1170
Practice Address - Fax:718-368-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02079532Medicaid
NYWK5711Medicare ID - Type Unspecified