Provider Demographics
NPI:1982931218
Name:INTERPUBLIC MEDICAL PC
Entity Type:Organization
Organization Name:INTERPUBLIC MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:I
Authorized Official - Last Name:PUBLICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-690-4237
Mailing Address - Street 1:PO BOX 520391
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0391
Mailing Address - Country:US
Mailing Address - Phone:718-690-4237
Mailing Address - Fax:
Practice Address - Street 1:1005 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2413
Practice Address - Country:US
Practice Address - Phone:718-690-4237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184001170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01934192Medicaid