Healthcare Provider Details

I. General information

NPI: 1366613630
Provider Name (Legal Business Name): INTEGRATED MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE FL 12
NEW YORK NY
10016-5438
US

IV. Provider business mailing address

40 BAYARD LN
PRINCETON NJ
08540-3029
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-8689
  • Fax:
Mailing address:
  • Phone: 609-924-7576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOAN LEVITT
Title or Position: BUSINESS MAMAGER
Credential:
Phone: 609-924-7576