MEDICARE: INTEGRATIVE PEDIATRIC AND ADOLESCENT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386281459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE PEDIATRIC AND ADOLESCENT CARE

Provider Business Mailing Address
First Line	:	160 MOUNTAIN AVE STE 100
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	908-852-8787
Fax Number	:	908-852-8187

Provider Business Practice Location Address
First Line	:	160 MOUNTAIN AVE STE 100
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	908-852-8787
Fax Number	:	908-852-8187

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHILPY SETYA
Credential	:	MD
Telephone Number	:	908-852-8787

Provider Enumeration Date	:	12/07/2019
Last Update Date	:	12/07/2019

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Directions to “INTEGRATIVE PEDIATRIC AND ADOLESCENT CARE ” Practice Location

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