Provider Demographics
NPI:1336745058
Name:INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:REKLAME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHASTE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-790-4511
Mailing Address - Street 1:157 E 86TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2175
Mailing Address - Country:US
Mailing Address - Phone:718-790-4511
Mailing Address - Fax:646-809-8707
Practice Address - Street 1:157 E 86TH ST STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2175
Practice Address - Country:US
Practice Address - Phone:718-790-4511
Practice Address - Fax:646-809-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty