Provider Demographics
NPI:1922495092
Name:INTEGRATIVE MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DELAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATOPP
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:203-916-3233
Mailing Address - Street 1:917 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6738
Mailing Address - Country:US
Mailing Address - Phone:203-916-3233
Mailing Address - Fax:
Practice Address - Street 1:917 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6738
Practice Address - Country:US
Practice Address - Phone:203-916-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133N00000X133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty