Provider Demographics
NPI:1568536571
Name:INTERNAL MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LYGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-593-1391
Mailing Address - Street 1:182 EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2627
Mailing Address - Country:US
Mailing Address - Phone:516-593-8648
Mailing Address - Fax:516-593-6202
Practice Address - Street 1:182 EARLE AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2627
Practice Address - Country:US
Practice Address - Phone:516-593-8648
Practice Address - Fax:516-593-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74I631Medicare ID - Type Unspecified
NYF93537Medicare UPIN