Provider Demographics
NPI:1437741295
Name:INTEGRATED WELLNESS CLINIC PC
Entity Type:Organization
Organization Name:INTEGRATED WELLNESS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-265-0500
Mailing Address - Street 1:491 ALLENDALE RD STE 222
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1431
Mailing Address - Country:US
Mailing Address - Phone:610-265-0500
Mailing Address - Fax:610-265-0502
Practice Address - Street 1:491 ALLENDALE RD STE 222
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1431
Practice Address - Country:US
Practice Address - Phone:610-265-0500
Practice Address - Fax:610-265-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1972758464Medicaid
PA1154433316Medicaid