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General NPI Number Information
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NPI Number | 1245574151
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Entity Type | Organization
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Legal Business Name | INTEGRA HOME HEALTH IPA, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 40 EXCHANGE PL SUITE 1705
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City | NEW YORK
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State | NY
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Zip | 10005-2701
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Country | US
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Telephone | 718-369-0012
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Fax | 718-287-1229
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Provider Business Mailing Address
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Address Line | 40 EXCHANGE PL SUITE 1705
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City | NEW YORK
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State | NY
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Zip | 10005-2701
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Country | US
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Telephone | 718-369-0012
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Fax | 718-287-1229
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Authorized Official
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Title or Position | CEO
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Name | MR. ANDREW SALTOUN
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Credential |
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Telephone | 718-819-3903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | NY
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