Provider Demographics
NPI:1417353558
Name:SYNERGY INTEGRATED MEDICAL PA
Entity Type:Organization
Organization Name:SYNERGY INTEGRATED MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-777-0778
Mailing Address - Street 1:807 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-5323
Mailing Address - Country:US
Mailing Address - Phone:302-777-0778
Mailing Address - Fax:302-777-4002
Practice Address - Street 1:807 N UNION ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-5323
Practice Address - Country:US
Practice Address - Phone:302-777-0778
Practice Address - Fax:302-777-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE408233Medicare PIN