Provider Demographics
NPI:1215587670
Name:IMED SURGICAL OF ATLANTA PC
Entity Type:Organization
Organization Name:IMED SURGICAL OF ATLANTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:631-760-1548
Mailing Address - Street 1:113 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0968
Mailing Address - Country:US
Mailing Address - Phone:631-760-1548
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE PL NW STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2117
Practice Address - Country:US
Practice Address - Phone:631-760-1548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA