Provider Demographics
NPI:1639671407
Name:JM MEDICINE INTEGRATIVE
Entity Type:Organization
Organization Name:JM MEDICINE INTEGRATIVE
Other - Org Name:JM MEDICINE INTEGRATIVE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-MICHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ETE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-292-9455
Mailing Address - Street 1:255 W 19TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4001
Mailing Address - Country:US
Mailing Address - Phone:917-292-9455
Mailing Address - Fax:
Practice Address - Street 1:12 W 27TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6903
Practice Address - Country:US
Practice Address - Phone:917-292-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty