| East Side Integrative Medicine Pc | |
|
1 Barker Ave Ste 200 White Plains NY 10601-1523 | |
| (845) 422-6504 | |
| Not Available |
| Full Name | East Side Integrative Medicine Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1 Barker Ave Ste 200, White Plains, New York |
| Authorized Official Name and Position | Benjamin James Medrano (DIRECTOR) |
| Authorized Official Contact | 7202519215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Side Integrative Medicine Pc 1 Barker Ave Ste 200 White Plains NY 10601-1523 Ph: (845) 422-6504 | East Side Integrative Medicine Pc 1 Barker Ave Ste 200 White Plains NY 10601-1523 Ph: (845) 422-6504 |
| NPI Number | 1659081461 |
|---|---|
| Provider Enumeration Date | 12/02/2022 |
| Last Update Date | 07/10/2023 |
| Certification Date | 07/10/2023 |
| Medicare PECOS PAC ID | 6709245939 |
|---|---|
| Medicare Enrollment ID | O20230706003225 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659081461 | NPI | - | NPPES |
| 284877 | Other | NY | PSYCHIATRIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Amy Della Rocca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093994378 PECOS PAC ID: 5890920102 Enrollment ID: I20131022001453 |
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