Provider Demographics
NPI:1205127669
Name:TARGEE STREET INTERNAL MEDICINE GROUP
Entity type:Organization
Organization Name:TARGEE STREET INTERNAL MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINO
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-447-4023
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 317B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4401
Mailing Address - Country:US
Mailing Address - Phone:718-447-4023
Mailing Address - Fax:718-273-2025
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 317B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4401
Practice Address - Country:US
Practice Address - Phone:718-447-4023
Practice Address - Fax:718-273-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty