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General NPI Number Information
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NPI Number | 1063010718
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICINE PSYCHIATRY P.C.
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 200 PROSPECT PARK W STE 1R
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City | BROOKLYN
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State | NY
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Zip | 11215-5717
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Country | US
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Telephone | 212-621-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 200 PROSPECT PARK W STE 1R
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City | BROOKLYN
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State | NY
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Zip | 11215-5717
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Country | US
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Telephone | 212-621-7770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEATA LEWIS
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Credential | MD
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Telephone | 617-794-8391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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