=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972761658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY MEDICAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W 27TH ST FOURTH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-255-8992
-----------------------------------------------------
Fax | 212-463-9526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W 27TH ST FOURTH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-255-8992
-----------------------------------------------------
Fax | 212-463-9526
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONALD SAMUEL MATHESON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-255-8992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 169748
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------