Provider Demographics
NPI:1760701031
Name:ADVANCED INTERNAL MEDICAL CARE ,LLC
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICAL CARE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAKOLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-313-0438
Mailing Address - Street 1:1664 E 14TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1162
Mailing Address - Country:US
Mailing Address - Phone:718-313-0438
Mailing Address - Fax:718-396-0407
Practice Address - Street 1:1664 E 14TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1162
Practice Address - Country:US
Practice Address - Phone:718-998-2350
Practice Address - Fax:718-998-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty