Healthcare Provider Details

I. General information

NPI: 1912720574
Provider Name (Legal Business Name): INTEGRATIVE MEDICINE OF MIDTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 PARK AVE FRNT 1B
NEW YORK NY
10021-4248
US

IV. Provider business mailing address

3505 HILL BLVD STE C
YORKTOWN HEIGHTS NY
10598-1210
US

V. Phone/Fax

Practice location:
  • Phone: 646-833-0310
  • Fax: 213-375-3794
Mailing address:
  • Phone: 914-613-3653
  • Fax: 213-375-3794

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 Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONICA GROVER
Title or Position: PHYSICIAN, OWNER
Credential: DO
Phone: 646-833-0310