Provider Demographics
NPI:1356097109
Name:INTEGRATIVE BY L&M
Entity Type:Organization
Organization Name:INTEGRATIVE BY L&M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUMTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATHIRAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-654-5151
Mailing Address - Street 1:1122 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2812
Mailing Address - Country:US
Mailing Address - Phone:908-654-5151
Mailing Address - Fax:
Practice Address - Street 1:1122 ROUTE 22
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2812
Practice Address - Country:US
Practice Address - Phone:908-654-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty