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General NPI Number Information
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NPI Number | 1255290466
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Entity Type | Organization
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Legal Business Name | INTEGRALMED NP IN PRIMARY CARE
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 30 RINGTOP RD
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City | KINGSTON
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State | NY
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Zip | 12401-6155
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Country | US
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Telephone | 845-489-1073
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Fax |
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Provider Business Mailing Address
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Address Line | 8 N FRONT ST # 1002
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City | KINGSTON
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State | NY
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Zip | 12401-3814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAMILLE ANNE WALLACE
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Credential | NP
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Telephone | 845-489-1073
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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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