Provider Demographics
NPI:1356489173
Name:RIM MEDICAL PC
Entity Type:Organization
Organization Name:RIM MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:718-934-8484
Mailing Address - Street 1:2818 OCEAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3170
Mailing Address - Country:US
Mailing Address - Phone:718-934-8484
Mailing Address - Fax:718-934-4267
Practice Address - Street 1:2818 OCEAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3170
Practice Address - Country:US
Practice Address - Phone:718-934-8484
Practice Address - Fax:718-934-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02472140Medicaid
NY02472140Medicaid