Provider Demographics
NPI:1235333550
Name:IES MEDICAL
Entity Type:Organization
Organization Name:IES MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-726-0404
Mailing Address - Street 1:3804 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3800
Mailing Address - Country:US
Mailing Address - Phone:718-726-0404
Mailing Address - Fax:
Practice Address - Street 1:3804 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3800
Practice Address - Country:US
Practice Address - Phone:718-726-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028614261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy