Provider Demographics
NPI:1457643785
Name:INTERFAITH EMERGENCY MEDICINE, P.C.
Entity Type:Organization
Organization Name:INTERFAITH EMERGENCY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGYARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-613-4708
Mailing Address - Street 1:1545 ATLANTIC AVENUE
Mailing Address - Street 2:FACULTY PRACTICE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1122
Mailing Address - Country:US
Mailing Address - Phone:718-613-4708
Mailing Address - Fax:
Practice Address - Street 1:1545 ATLANTIC AVENUE
Practice Address - Street 2:FACULTY PRACTICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty