Healthcare Provider Details

I. General information

NPI: 1275533895
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HAMILTON WAY
CASTLETON NY
12033-1015
US

IV. Provider business mailing address

22 HAMILTON WAY
CASTLETON NY
12033-1015
US

V. Phone/Fax

Practice location:
  • Phone: 203-856-8550
  • Fax: 888-417-9343
Mailing address:
  • Phone: 203-856-8550
  • Fax: 888-417-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DAN RATNER
Title or Position: ADMIN
Credential:
Phone: 203-856-8550