Provider Demographics
NPI:1962800698
Name:INTELLEX PRO GROUP INC
Entity type:Organization
Organization Name:INTELLEX PRO GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TETYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEVYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-909-3607
Mailing Address - Street 1:1580 E 18TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7273
Mailing Address - Country:US
Mailing Address - Phone:347-909-3607
Mailing Address - Fax:347-338-2800
Practice Address - Street 1:1580 E 18TH ST APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7273
Practice Address - Country:US
Practice Address - Phone:347-909-3607
Practice Address - Fax:347-338-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization