Provider Demographics
NPI:1437487386
Name:CAMBRIA HEIGHTS MEDICAL CARE PC
Entity type:Organization
Organization Name:CAMBRIA HEIGHTS MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-898-3137
Mailing Address - Street 1:21916 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411
Mailing Address - Country:US
Mailing Address - Phone:631-898-3137
Mailing Address - Fax:
Practice Address - Street 1:21916 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1619
Practice Address - Country:US
Practice Address - Phone:631-898-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty