Provider Demographics
NPI:1316072325
Name:POLYMED COMMUNITY CARE,PC
Entity type:Organization
Organization Name:POLYMED COMMUNITY CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-645-2335
Mailing Address - Street 1:282 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5934
Mailing Address - Country:US
Mailing Address - Phone:718-645-2335
Mailing Address - Fax:718-645-3404
Practice Address - Street 1:282 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5934
Practice Address - Country:US
Practice Address - Phone:718-645-2335
Practice Address - Fax:718-645-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEK971Medicare ID - Type Unspecified