Provider Demographics
NPI:1841615630
Name:INTEGRA MLTC INC.
Entity Type:Organization
Organization Name:INTEGRA MLTC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORIGAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-468-4747
Mailing Address - Street 1:22215 NORTHERN BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3678
Mailing Address - Country:US
Mailing Address - Phone:718-468-4747
Mailing Address - Fax:718-264-5834
Practice Address - Street 1:2701 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2209
Practice Address - Country:US
Practice Address - Phone:347-505-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization