Healthcare Provider Details

I. General information

NPI: 1518261163
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL ASSOCIATES OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 KENWOOD AVE
DELMAR NY
12054-3228
US

IV. Provider business mailing address

388 KENWOOD AVE
DELMAR NY
12054-3228
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-2244
  • Fax: 518-689-2081
Mailing address:
  • Phone: 518-689-2244
  • Fax: 518-689-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD L STRAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-689-2244