Provider Demographics
NPI:1265855944
Name:INTERFAITH MEDICAL CENTER
Entity Type:Organization
Organization Name:INTERFAITH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-613-4000
Mailing Address - Street 1:10517 77TH ST
Mailing Address - Street 2:FL 2
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1010
Mailing Address - Country:US
Mailing Address - Phone:214-762-8794
Mailing Address - Fax:
Practice Address - Street 1:10517 77TH ST
Practice Address - Street 2:FL 2
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1010
Practice Address - Country:US
Practice Address - Phone:214-762-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty