Provider Demographics
NPI:1386832913
Name:IB FAMILY MEDICAL PC
Entity Type:Organization
Organization Name:IB FAMILY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDITSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-576-1212
Mailing Address - Street 1:3743 MERMAID AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1234
Mailing Address - Country:US
Mailing Address - Phone:718-576-1212
Mailing Address - Fax:718-332-7110
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:STE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7870
Practice Address - Country:US
Practice Address - Phone:718-576-1212
Practice Address - Fax:718-332-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386832913Medicare UPIN