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General NPI Number Information
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NPI Number | 1255091831
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Entity Type | Organization
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Legal Business Name | MODERN INTEGRATIVE WELLNESS NP IN PSYCHIATRY PC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 125 E 23RD ST STE 300
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City | NEW YORK
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State | NY
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Zip | 10010-4588
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Country | US
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Telephone | 646-650-5032
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BRYCE AVE
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City | GLEN COVE
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State | NY
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Zip | 11542-2013
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Country | US
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Telephone | 347-520-2837
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALANNA MONTALVAN
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Credential | NP
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Telephone | 646-650-5032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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