Provider Demographics
NPI:1104124924
Name:IG MEDICAL PC
Entity type:Organization
Organization Name:IG MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-569-8070
Mailing Address - Street 1:570 W 204TH ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4011
Mailing Address - Country:US
Mailing Address - Phone:212-569-8070
Mailing Address - Fax:212-569-8071
Practice Address - Street 1:570 W 204TH ST APT 1J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4011
Practice Address - Country:US
Practice Address - Phone:212-569-8070
Practice Address - Fax:212-569-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2363851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02711255Medicaid
I41199Medicare UPIN