Healthcare Provider Details

I. General information

NPI: 1811128564
Provider Name (Legal Business Name): INTEGRATIVE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 21ST ST SUITE 400
NEW YORK NY
10010-6904
US

IV. Provider business mailing address

22 W 21ST ST SUITE 400
NEW YORK NY
10010-6904
US

V. Phone/Fax

Practice location:
  • Phone: 212-366-5100
  • Fax: 212-366-6275
Mailing address:
  • Phone: 212-366-5100
  • Fax: 212-366-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234008
License Number StateNY

VIII. Authorized Official

Name: DR. ARAN DEGENHARDT
Title or Position: MEDICAL DIRECTOR
Credential: MD, MPH&TM
Phone: 212-366-5100