Healthcare Provider Details

I. General information

NPI: 1538948823
Provider Name (Legal Business Name): SMART INTEGRATED HEALTHCARE NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 MAIN ST STE 201
NEW ROCHELLE NY
10801-6360
US

IV. Provider business mailing address

130 WHITE HORSE PIKE
CLEMENTON NJ
08021-4159
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-9101
  • Fax: 570-622-9102
Mailing address:
  • Phone: 570-622-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAHEEL SIDDIQUI
Title or Position: COO
Credential:
Phone: 856-264-7024