Provider Demographics
NPI:1538289715
Name:INTEGRATED HEALTHCARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZAZZALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-844-0511
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0598
Mailing Address - Country:US
Mailing Address - Phone:973-844-0511
Mailing Address - Fax:
Practice Address - Street 1:670 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1259
Practice Address - Country:US
Practice Address - Phone:973-844-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8152101Medicaid
NJ8152004Medicaid
NJ7220103Medicaid
NJ8151806Medicaid
NJ7220103Medicaid