MEDICARE: FUNCTIONAL AND INTEGRATIVE MEDICAL HEALTH CARE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	259884	NY
2	207Q00000X	Family Medicine Physician	259884	NY

General Provider Information

NPI Number	:	1417217613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL AND INTEGRATIVE MEDICAL HEALTH CARE P.C.

Provider Business Mailing Address
First Line	:	3505 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2026
Country	:	US
Telephone Number	:	718-732-4210
Fax Number	:	888-761-8317

Provider Business Practice Location Address
First Line	:	3505 E TREMONT AVE
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10465-2026
Country	:	US
Telephone Number	:	718-732-4210
Fax Number	:	888-761-8317

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	AJAY N KIRI
Credential	:	M.D.
Telephone Number	:	908-421-6101

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/07/2015

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