Healthcare Provider Details

I. General information

NPI: 1578937579
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL SOLUTIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2015
Last Update Date: 11/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUMMER ST SUITE 205
STAMFORD CT
06905-5546
US

IV. Provider business mailing address

999 SUMMER ST SUITE 205
STAMFORD CT
06905-5546
US

V. Phone/Fax

Practice location:
  • Phone: 203-614-8600
  • Fax: 203-614-8598
Mailing address:
  • Phone: 203-614-8600
  • Fax: 203-614-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number043130
License Number StateCT

VIII. Authorized Official

Name: DR. RICHARD CARL KOFFLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 917-903-4531