Basic Information
| Provider Information | |||||||||
| NPI: | 1811210826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRAL ASSIST MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9941 64TH AVE | ||||||||
| Address2: | SUITE D16 | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113742653 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 9941 64TH AVE | ||||||||
| Address2: | SUITE D16 | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113742653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168837100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2010 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | ACKERMAN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7185314545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.