Provider Demographics
NPI:1609390715
Name:IMG NY LLC
Entity Type:Organization
Organization Name:IMG NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMENAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-564-1303
Mailing Address - Street 1:80 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2541
Mailing Address - Country:US
Mailing Address - Phone:800-564-1303
Mailing Address - Fax:
Practice Address - Street 1:80 STATE ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2541
Practice Address - Country:US
Practice Address - Phone:800-564-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty