Provider Demographics
NPI:1861020810
Name:INTEGRATED MEDICAL HEALTHCARE SERVICES PLLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL HEALTHCARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:HARDY
Authorized Official - Last Name:CARLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-490-8519
Mailing Address - Street 1:600 STONY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6524
Mailing Address - Country:US
Mailing Address - Phone:845-391-8557
Mailing Address - Fax:845-608-8270
Practice Address - Street 1:600 STONY BROOK CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6524
Practice Address - Country:US
Practice Address - Phone:845-391-8557
Practice Address - Fax:845-608-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty