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General NPI Number Information
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NPI Number | 1841594447
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FAMILY CARE AT THE SPRINGS PLLC
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 115 SULLYS TRL STE 4
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City | PITTSFORD
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State | NY
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Zip | 14534-4571
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Country | US
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Telephone | 315-462-3553
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Fax | 315-462-3104
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Provider Business Mailing Address
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Address Line | 115 SULLYS TRL STE 4
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City | PITTSFORD
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State | NY
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Zip | 14534-4571
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Country | US
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Telephone | 315-462-3553
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Fax | 315-462-3104
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARY L COAN
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Credential |
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Telephone | 315-462-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 214314
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License Number State | NY
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