Provider Demographics
NPI:1417526773
Name:INNOVATIVE THERAPY GROUP
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY GROUP
Other - Org Name:ITG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-523-0531
Mailing Address - Street 1:3492 BENDEMEER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1913
Mailing Address - Country:US
Mailing Address - Phone:917-485-1519
Mailing Address - Fax:
Practice Address - Street 1:3492 BENDEMEER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1913
Practice Address - Country:US
Practice Address - Phone:917-485-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty