Provider Demographics
NPI:1336311133
Name:INTEGRAL MEDICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:INTEGRAL MEDICAL PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NABEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-966-2464
Mailing Address - Street 1:PO BOX 360543
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-0543
Mailing Address - Country:US
Mailing Address - Phone:718-789-2600
Mailing Address - Fax:718-789-5504
Practice Address - Street 1:135 EASTERN PKWY
Practice Address - Street 2:SUITE 1-I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6054
Practice Address - Country:US
Practice Address - Phone:718-789-2600
Practice Address - Fax:178-789-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1973292081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG32201Medicare UPIN