MEDICARE: BRONX INTEGRATIVE CARE NP IN FAMILY HEALTH PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TB0200X	Cognitive & Behavioral Psychologist
2	103TC0700X	Clinical Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	1041C0700X	Clinical Social Worker
5	171M00000X	Case Manager/Care Coordinator
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
7	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1568395093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX INTEGRATIVE CARE NP IN FAMILY HEALTH PLLC

Provider Business Mailing Address
First Line	:	638 E 169TH ST FRNT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-2411
Country	:	US
Telephone Number	:	917-916-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	638 E 169TH ST FRNT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-2411
Country	:	US
Telephone Number	:	917-916-9322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAUL ALEJANDRO HERRERA IZQUIERDO
Credential	:	FNP-BC ,CMGT-BC
Telephone Number	:	917-916-9322

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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