Provider Demographics
NPI:1497776652
Name:IDA MEDICAL PLAZA PC
Entity Type:Organization
Organization Name:IDA MEDICAL PLAZA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLURFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-853-8503
Mailing Address - Street 1:1379 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4259
Mailing Address - Country:US
Mailing Address - Phone:718-853-8503
Mailing Address - Fax:718-853-8498
Practice Address - Street 1:1379 54TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4259
Practice Address - Country:US
Practice Address - Phone:718-853-8503
Practice Address - Fax:718-853-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty