Provider Demographics
NPI:1245523984
Name:NYACK INTEGRATED MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:NYACK INTEGRATED MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PELZIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-353-3267
Mailing Address - Street 1:42 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3204
Mailing Address - Country:US
Mailing Address - Phone:845-353-3267
Mailing Address - Fax:845-353-3628
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3204
Practice Address - Country:US
Practice Address - Phone:845-353-3267
Practice Address - Fax:845-353-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0035721171100000X
NY146693208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01347144Medicaid
NY01347144Medicaid