Provider Demographics
NPI:1881950491
Name:INTERBORO OB/GYN ASSOCIATES, P.C.
Entity type:Organization
Organization Name:INTERBORO OB/GYN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGARGIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-987-8787
Mailing Address - Street 1:1145 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4300
Mailing Address - Country:US
Mailing Address - Phone:718-668-3600
Mailing Address - Fax:
Practice Address - Street 1:1145 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4300
Practice Address - Country:US
Practice Address - Phone:718-668-3600
Practice Address - Fax:718-987-9610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133084173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY341061Medicare UPIN