Provider Demographics
NPI:1518174267
Name:IDMED CARE PLLC
Entity type:Organization
Organization Name:IDMED CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CALUBIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-858-1732
Mailing Address - Street 1:PO BOX 23424
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202
Mailing Address - Country:US
Mailing Address - Phone:718-858-1732
Mailing Address - Fax:718-596-3332
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:STE 9B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-858-1732
Practice Address - Fax:718-596-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175306207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0162374Medicaid
NY129AM1Medicare ID - Type Unspecified
NY0162374Medicaid