Healthcare Provider Details

I. General information

NPI: 1790700599
Provider Name (Legal Business Name): INTEGRATED HEALTH ADMINISTRATIVE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HALSTEAD AVE SUITE 304
MAMARONECK NY
10543-2607
US

IV. Provider business mailing address

141 HALSTEAD AVE SUITE 304
MAMARONECK NY
10543-2607
US

V. Phone/Fax

Practice location:
  • Phone: 914-777-8300
  • Fax: 914-777-8304
Mailing address:
  • Phone: 914-777-8300
  • Fax: 914-777-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LEONARD J TANZER
Title or Position: CHAIRMAN
Credential:
Phone: 914-777-8300