Provider Demographics
NPI:1205395779
Name:INTEGRATIVE PSYCHIATRY
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNADETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-592-0869
Mailing Address - Street 1:425 W 23RD ST RM 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1436
Mailing Address - Country:US
Mailing Address - Phone:646-592-0869
Mailing Address - Fax:
Practice Address - Street 1:425 W 23RD ST RM 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1436
Practice Address - Country:US
Practice Address - Phone:646-592-0869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty