Provider Demographics
NPI:1275610545
Name:INNOVATIVE HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-683-8050
Mailing Address - Street 1:7 HOLLAND AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3317
Mailing Address - Country:US
Mailing Address - Phone:914-683-8050
Mailing Address - Fax:914-683-8054
Practice Address - Street 1:7 HOLLAND AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3317
Practice Address - Country:US
Practice Address - Phone:914-683-8050
Practice Address - Fax:914-683-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060810830261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01037705Medicaid
NY1629197264Medicaid