Provider Demographics
NPI:1417217613
Name:FUNCTIONAL AND INTEGRATIVE MEDICAL HEALTH CARE P.C.
Entity Type:Organization
Organization Name:FUNCTIONAL AND INTEGRATIVE MEDICAL HEALTH CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:KIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-421-6101
Mailing Address - Street 1:3505 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2026
Mailing Address - Country:US
Mailing Address - Phone:718-732-4210
Mailing Address - Fax:888-761-8317
Practice Address - Street 1:3505 E TREMONT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2026
Practice Address - Country:US
Practice Address - Phone:718-732-4210
Practice Address - Fax:888-761-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259884171100000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty