MEDICARE: INTEGRATED MEDICAL CENTER, P.A.

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	111N00000X	Chiropractor	MC03621	NJ
2	225100000X	Physical Therapist	QA008981	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700942356	OTHER	NJ	NPI
2	1043376692	OTHER	NJ	NPI

General Provider Information

NPI Number	:	1548482367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MEDICAL CENTER, P.A.

Provider Business Mailing Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-4400
Fax Number	:	973-546-5459

Provider Business Practice Location Address
First Line	:	357 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1654
Country	:	US
Telephone Number	:	973-546-4400
Fax Number	:	973-546-5459

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES F BONANNO
Credential	:	D.C.
Telephone Number	:	973-546-4400

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/11/2025

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