Provider Demographics
NPI:1578937579
Name:INTEGRATIVE MEDICAL SOLUTIONS, PC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-903-4531
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-614-8600
Mailing Address - Fax:203-614-8598
Practice Address - Street 1:999 SUMMER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-614-8600
Practice Address - Fax:203-614-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0431302081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty