Provider Demographics
NPI:1275877516
Name:EVIDENCE BASED MEDICINE INC
Entity Type:Organization
Organization Name:EVIDENCE BASED MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:INNERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-392-2339
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:AUSTERLITZ
Mailing Address - State:NY
Mailing Address - Zip Code:12017-0054
Mailing Address - Country:US
Mailing Address - Phone:518-392-2339
Mailing Address - Fax:845-230-6639
Practice Address - Street 1:165 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2906
Practice Address - Country:US
Practice Address - Phone:516-801-0170
Practice Address - Fax:845-230-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118187207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE15407Medicare UPIN