MEDICARE: INTEGRATED MEDICAL HEALTH SERVICES PC

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	207Q00000X	Family Medicine Physician	198983	NY

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	:	1972980845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MEDICAL HEALTH SERVICES PC

Provider Business Mailing Address
First Line	:	20215 46TH RD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3059
Country	:	US
Telephone Number	:	347-414-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 LIVINGSTON ST STE 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5023
Country	:	US
Telephone Number	:	347-414-3070
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CATHY DELERME PAGAN
Credential	:	MD
Telephone Number	:	347-414-3070

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	02/02/2017

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