Provider Demographics
NPI:1831567809
Name:AIM INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:AIM INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-802-5027
Mailing Address - Street 1:80 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2047
Mailing Address - Country:US
Mailing Address - Phone:516-802-5027
Mailing Address - Fax:
Practice Address - Street 1:80 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2047
Practice Address - Country:US
Practice Address - Phone:516-802-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13257912080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare PIN