Provider Demographics
NPI:1114384450
Name:INTEGRATED MEDICINE & PT
Entity Type:Organization
Organization Name:INTEGRATED MEDICINE & PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-838-6252
Mailing Address - Street 1:300 KAKEOUT RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2548
Mailing Address - Country:US
Mailing Address - Phone:973-838-6252
Mailing Address - Fax:
Practice Address - Street 1:300 KAKEOUT RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2548
Practice Address - Country:US
Practice Address - Phone:973-838-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124639Medicare UPIN