Healthcare Provider Details

I. General information

NPI: 1811210826
Provider Name (Legal Business Name): INTEGRAL ASSIST MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9941 64TH AVE SUITE D16
REGO PARK NY
11374-2653
US

IV. Provider business mailing address

9941 64TH AVE SUITE D16
REGO PARK NY
11374-2653
US

V. Phone/Fax

Practice location:
  • Phone: 516-883-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAUL ACKERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-531-4545