Provider Demographics
NPI:1427232503
Name:INTEGRATIVE OSTEOPATHIC MULTISPECIALTY MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE OSTEOPATHIC MULTISPECIALTY MEDICAL ASSOCIATES, PLLC
Other - Org Name:IOMMA PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-741-1364
Mailing Address - Street 1:471 N BROADWAY STE 351
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2106
Mailing Address - Country:US
Mailing Address - Phone:516-639-7774
Mailing Address - Fax:
Practice Address - Street 1:471 N BROADWAY STE 351
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2106
Practice Address - Country:US
Practice Address - Phone:516-639-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229958204D00000X, 207Q00000X
NY229953204D00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty