Provider Demographics
NPI:1669645628
Name:IZGEL MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:IZGEL MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERTH
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-6434
Mailing Address - Street 1:2327 83RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-645-6434
Mailing Address - Fax:718-382-5252
Practice Address - Street 1:2327 83RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-645-6434
Practice Address - Fax:718-382-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100000389Medicare PIN
NYWZT4K1Medicare PIN
NYG400002755Medicare PIN