Provider Demographics
NPI:1619291085
Name:INTERGRATIVE PHYSICIAN CONSULTANT GROUP LLC
Entity Type:Organization
Organization Name:INTERGRATIVE PHYSICIAN CONSULTANT GROUP LLC
Other - Org Name:THE CENTER FOR HEALING LIGHT & INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-270-2053
Mailing Address - Street 1:438 GANTTOWN RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2341
Mailing Address - Country:US
Mailing Address - Phone:856-270-2053
Mailing Address - Fax:856-270-2061
Practice Address - Street 1:438 GANTTOWN RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2341
Practice Address - Country:US
Practice Address - Phone:856-270-2053
Practice Address - Fax:856-270-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty