Provider Demographics
NPI:1821198979
Name:SELF HEALTH CARE CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:SELF HEALTH CARE CENTERS OF AMERICA LLC
Other - Org Name:INTEGRATIVE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONUZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-641-9009
Mailing Address - Street 1:201 E BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2737
Mailing Address - Country:US
Mailing Address - Phone:609-641-9009
Mailing Address - Fax:609-641-3918
Practice Address - Street 1:201 E BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2737
Practice Address - Country:US
Practice Address - Phone:609-641-9009
Practice Address - Fax:609-641-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD19359Medicare UPIN
NJ108588RMMMedicare PIN