Provider Demographics
NPI:1003184722
Name:INTEGRATIVE MEDICAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-903-4531
Mailing Address - Street 1:1 ATLANTIC ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2482
Mailing Address - Country:US
Mailing Address - Phone:203-355-2225
Mailing Address - Fax:203-355-2235
Practice Address - Street 1:1 ATLANTIC ST
Practice Address - Street 2:2ND FLR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2482
Practice Address - Country:US
Practice Address - Phone:203-355-2225
Practice Address - Fax:203-355-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty