Provider Demographics
NPI:1457981979
Name:INTEGRA MLTC INC.
Entity Type:Organization
Organization Name:INTEGRA MLTC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS AND PRODUCT DEVELOPMENT LD
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-800-4683
Mailing Address - Street 1:3 DAKOTA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1166
Mailing Address - Country:US
Mailing Address - Phone:855-800-4683
Mailing Address - Fax:
Practice Address - Street 1:1981 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2060
Practice Address - Country:US
Practice Address - Phone:855-800-4683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization