Healthcare Provider Details

I. General information

NPI: 1568395093
Provider Name (Legal Business Name): BRONX INTEGRATIVE CARE NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E 169TH ST FRNT 2
BRONX NY
10456-2411
US

IV. Provider business mailing address

638 E 169TH ST FRNT 2
BRONX NY
10456-2411
US

V. Phone/Fax

Practice location:
  • Phone: 917-916-9322
  • Fax:
Mailing address:
  • Phone: 917-916-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAUL ALEJANDRO HERRERA IZQUIERDO
Title or Position: OWNER
Credential: FNP-BC ,CMGT-BC
Phone: 917-916-9322