Provider Demographics
NPI:1669635173
Name:INTEGRA PARTNERS IPA LLC
Entity Type:Organization
Organization Name:INTEGRA PARTNERS IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-668-4081
Mailing Address - Street 1:INTEGRA PARTNERS PO BOX 81580
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308
Mailing Address - Country:US
Mailing Address - Phone:718-369-0012
Mailing Address - Fax:718-287-1229
Practice Address - Street 1:100 WALL STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-3701
Practice Address - Country:US
Practice Address - Phone:718-369-0012
Practice Address - Fax:718-287-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X, 332BC3200X, 332BX2000X, 335E00000X
332BC3200X, 332BP3500X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier