Provider Demographics
NPI:1235162256
Name:INTEGRATIVE & FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE & FAMILY HEALTHCARE LLC
Other - Org Name:DAVID J JEZYK MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:JEZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-999-8901
Mailing Address - Street 1:607 PARKER CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-995-2966
Mailing Address - Fax:
Practice Address - Street 1:2055 LIMESTONE RD
Practice Address - Street 2:STE 117
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-999-8901
Practice Address - Fax:302-999-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10D00967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00000191701Medicaid
DE00000191701Medicaid
DEG01457Medicare ID - Type Unspecified