Provider Demographics
NPI:1720629454
Name:INTERNATIONAL TRAVEL MEDICINE, PC
Entity Type:Organization
Organization Name:INTERNATIONAL TRAVEL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-626-2518
Mailing Address - Street 1:200 S SERVICE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2118
Mailing Address - Country:US
Mailing Address - Phone:516-626-2518
Mailing Address - Fax:516-626-2583
Practice Address - Street 1:200 S SERVICE RD STE 212
Practice Address - Street 2:
Practice Address - City:ROSLYN HTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2118
Practice Address - Country:US
Practice Address - Phone:516-626-2004
Practice Address - Fax:516-626-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty