Provider Demographics
NPI:1245337989
Name:IGOR AMIGUD PHYSICIAN P.C.
Entity type:Organization
Organization Name:IGOR AMIGUD PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIGUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-583-9701
Mailing Address - Street 1:211 E 53RD ST
Mailing Address - Street 2:SUITE 3-K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4803
Mailing Address - Country:US
Mailing Address - Phone:212-583-9701
Mailing Address - Fax:212-583-9709
Practice Address - Street 1:211 E 53RD ST
Practice Address - Street 2:SUITE 3-K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4803
Practice Address - Country:US
Practice Address - Phone:212-583-9701
Practice Address - Fax:212-583-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200459174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAW391Medicare ID - Type Unspecified
NYG63268Medicare UPIN