Provider Demographics
NPI:1437172525
Name:RYNDIN, IGOR (MD)
Entity Type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:RYNDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 E 19TH ST
Mailing Address - Street 2:# 1C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2245
Mailing Address - Country:US
Mailing Address - Phone:718-676-1180
Mailing Address - Fax:347-587-4082
Practice Address - Street 1:1773 E 19TH ST
Practice Address - Street 2:STE 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2245
Practice Address - Country:US
Practice Address - Phone:718-676-1180
Practice Address - Fax:347-587-4082
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2363851208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711255Medicaid
NY4S135ZWWQ1OtherMEDICARE ID TYPE UNSPECIFIED
NY08000Medicare PIN
I41199Medicare UPIN
NY02711255Medicaid