Provider Demographics
NPI:1811128564
Name:INTEGRATIVE FAMILY MEDICINE
Entity type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH&TM
Authorized Official - Phone:212-366-5100
Mailing Address - Street 1:22 W 21ST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6904
Mailing Address - Country:US
Mailing Address - Phone:212-366-5100
Mailing Address - Fax:212-366-6275
Practice Address - Street 1:22 W 21ST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6904
Practice Address - Country:US
Practice Address - Phone:212-366-5100
Practice Address - Fax:212-366-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty