Provider Demographics
NPI:1851071690
Name:IMMUNOCINE, LLC
Entity Type:Organization
Organization Name:IMMUNOCINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-814-2185
Mailing Address - Street 1:3422 BUSINESS CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD LUIS DONALDO COLOSO (AV TULUM) MANZANA 1
Practice Address - Street 2:
Practice Address - City:CANCUN
Practice Address - State:Q.R.
Practice Address - Zip Code:77504
Practice Address - Country:MX
Practice Address - Phone:888-575-2572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Single Specialty