Provider Demographics
NPI:1154649887
Name:IT MEDICAL ESSENCE PC
Entity Type:Organization
Organization Name:IT MEDICAL ESSENCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:718-934-2211
Mailing Address - Street 1:2728 KINGS HWY
Mailing Address - Street 2:APT. F11
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1768
Mailing Address - Country:US
Mailing Address - Phone:718-934-2211
Mailing Address - Fax:718-934-2225
Practice Address - Street 1:2995 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8387
Practice Address - Country:US
Practice Address - Phone:718-934-2211
Practice Address - Fax:718-934-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253007261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care