MEDICARE: AVITA INTEGRATIVE CARE, LLC

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	103T00000X	Psychologist	0450041113	NJ
2	103T00000X	Psychologist	021116	NY
3	103TC0700X	Clinical Psychologist	0450041113	NJ

General Provider Information

NPI Number	:	1821530148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVITA INTEGRATIVE CARE, LLC

Provider Business Mailing Address
First Line	:	440 WEST ST STE 312
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5028
Country	:	US
Telephone Number	:	888-242-2732
Fax Number	:	888-242-2732

Provider Business Practice Location Address
First Line	:	440 WEST ST STE 312
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5028
Country	:	US
Telephone Number	:	888-242-2732
Fax Number	:	888-242-2732

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	DR. KALMAN KHODIK
Credential	:	PSY.D
Telephone Number	:	888-242-2732

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	06/13/2022

Similar Medicare Providers

1578495248 — CHRISTOPHER SCANLAN LAC
Practice Location Address:

440 WEST ST
FORT LEE, NJ
07024-5028

Practice Phone: 800-285-1584
Practice Fax:

1184862997 — IRINA VOLYNSKY PHD
Practice Location Address:

440 WEST ST , SUITE 23
FORT LEE, NJ
07024-5028

Practice Phone: 917-657-8925
Practice Fax:

1225371503 — EMKA HOME CARE SERVICES INC
Practice Location Address:

440 WEST ST
FORT LEE, NJ
07024-5028

Practice Phone: 201-947-6000
Practice Fax: 201-947-6010

1699161802 — IRINA BASHKIROV LAC
Practice Location Address:

440 WEST ST STE 323
FORT LEE, NJ
07024-5028

Practice Phone: 917-667-0242
Practice Fax:

1285140939 — DR. EMILE TOBIAS BERK PH.D.
Practice Location Address:

440 WEST ST # 323
FORT LEE, NJ
07024-5028

Practice Phone: 347-879-0202
Practice Fax:

1710475827 — DR. FRANK JOSEPH MATONE PH.D,DHS,LCSW
Practice Location Address:

440 WEST ST
FORT LEE, NJ
07024-5028

Practice Phone: 201-450-8566
Practice Fax:

Directions to “AVITA INTEGRATIVE CARE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.