MEDICARE: INTEGRATED HEALTHCARE GROUP, 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669577318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTHCARE GROUP, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 7664
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-7664
Country	:	US
Telephone Number	:	201-866-3100
Fax Number	:	201-866-0321

Provider Business Practice Location Address
First Line	:	5600 KENNEDY BLVD W
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1256
Country	:	US
Telephone Number	:	201-866-3100
Fax Number	:	201-866-0321

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN VITIEVSKY
Credential	:	M.D.
Telephone Number	:	201-866-3100

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/16/2025

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