Healthcare Provider Details

I. General information

NPI: 1063010718
Provider Name (Legal Business Name): INTEGRATIVE MEDICINE PSYCHIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PROSPECT PARK W STE 1R
BROOKLYN NY
11215-5717
US

IV. Provider business mailing address

200 PROSPECT PARK W STE 1R
BROOKLYN NY
11215-5717
US

V. Phone/Fax

Practice location:
  • Phone: 212-621-7770
  • Fax:
Mailing address:
  • Phone: 212-621-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BEATA LEWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 617-794-8391