Provider Demographics
NPI:1083033559
Name:INTEGRATIVE CANCER THERAPEUTICS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CANCER THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEZARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-886-0976
Mailing Address - Street 1:4800 N FEDERAL HWY
Mailing Address - Street 2:SUITE B306
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5188
Mailing Address - Country:US
Mailing Address - Phone:561-886-0976
Mailing Address - Fax:
Practice Address - Street 1:4800 N. FEDERAL HWY.
Practice Address - Street 2:SUITE B300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-3409
Practice Address - Country:US
Practice Address - Phone:561-886-0976
Practice Address - Fax:561-367-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70312261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology