Provider Demographics
NPI:1811070048
Name:IS MEDICAL P.C.
Entity type:Organization
Organization Name:IS MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-377-4278
Mailing Address - Street 1:1685 OCEAN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5475
Mailing Address - Country:US
Mailing Address - Phone:718-377-4278
Mailing Address - Fax:
Practice Address - Street 1:621 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5126
Practice Address - Country:US
Practice Address - Phone:718-382-6669
Practice Address - Fax:718-382-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2304152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY533N71Medicare UPIN
NY06158GMedicare ID - Type UnspecifiedGHI QUEENS GROUP #
NYY05995Medicare UPIN
NYWU4751Medicare ID - Type UnspecifiedEMPIRE BROOKLYN GROUP #