Provider Demographics
NPI:1164827531
Name:INTEGRA PARTNERS IPA (FLORIDA), LLC
Entity Type:Organization
Organization Name:INTEGRA PARTNERS IPA (FLORIDA), LLC
Other - Org Name:INTEGRA PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-668-4081
Mailing Address - Street 1:PO BOX 81580 INTEGRA PARTNERS
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308
Mailing Address - Country:US
Mailing Address - Phone:718-368-0012
Mailing Address - Fax:
Practice Address - Street 1:100 WALL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3701
Practice Address - Country:US
Practice Address - Phone:718-368-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies