Provider Demographics
NPI:1639869738
Name:INTEGRATIVE PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJGENBAUM-TESLJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-763-2948
Mailing Address - Street 1:85 MAGNOLIA PL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5505
Mailing Address - Country:US
Mailing Address - Phone:917-763-2948
Mailing Address - Fax:
Practice Address - Street 1:85 MAGNOLIA PL
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5505
Practice Address - Country:US
Practice Address - Phone:917-763-2948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty