Provider Demographics
NPI:1174784524
Name:INTERNAL MEDICINE ASSOCIATES OF LONG BEACH
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF LONG BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:STATFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-431-1852
Mailing Address - Street 1:370 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3620
Mailing Address - Country:US
Mailing Address - Phone:516-431-1852
Mailing Address - Fax:
Practice Address - Street 1:370 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3620
Practice Address - Country:US
Practice Address - Phone:516-431-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty