Provider Demographics
NPI:1356886683
Name:WATER STREET WEST INTEGRATIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:WATER STREET WEST INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HALUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:607-767-6893
Mailing Address - Street 1:160 N MAIN ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2939
Mailing Address - Country:US
Mailing Address - Phone:607-767-6893
Mailing Address - Fax:866-453-2143
Practice Address - Street 1:160 N MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2939
Practice Address - Country:US
Practice Address - Phone:607-767-6893
Practice Address - Fax:866-453-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty