Provider Demographics
NPI:1275949026
Name:INTEGRATED MEDICINE OF MOUNT KISCO PLLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICINE OF MOUNT KISCO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-412-8537
Mailing Address - Street 1:495 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3405
Mailing Address - Country:US
Mailing Address - Phone:914-242-8844
Mailing Address - Fax:917-536-9787
Practice Address - Street 1:495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3405
Practice Address - Country:US
Practice Address - Phone:914-242-8844
Practice Address - Fax:917-536-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227852261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center