Provider Demographics
NPI:1396361192
Name:INTEGRATIVE MEDICINE OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICINE OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-759-4200
Mailing Address - Street 1:520 FRANKLIN AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5878
Mailing Address - Country:US
Mailing Address - Phone:516-759-4200
Mailing Address - Fax:516-759-7600
Practice Address - Street 1:520 FRANKLIN AVE STE 230
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5878
Practice Address - Country:US
Practice Address - Phone:516-759-4200
Practice Address - Fax:516-759-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477637312OtherNYSED