Provider Demographics
NPI:1790700599
Name:INTEGRATED HEALTH ADMINISTRATIVE SERVICES INC.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH ADMINISTRATIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-777-8300
Mailing Address - Street 1:141 HALSTEAD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2607
Mailing Address - Country:US
Mailing Address - Phone:914-777-8300
Mailing Address - Fax:914-777-8304
Practice Address - Street 1:141 HALSTEAD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2607
Practice Address - Country:US
Practice Address - Phone:914-777-8300
Practice Address - Fax:914-777-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878633Medicaid
NJ630001541OtherRAILROAD MEDICARE
NY01879836Medicaid
NJ0060372Medicaid
NY630001618OtherRAILROAD MEDICARE
NJ0060372Medicaid
NY03609Medicare ID - Type Unspecified
NY01878633Medicaid
CT630000039Medicare ID - Type Unspecified
NY01879836Medicaid