| Integrated Care Group Llc | |
|
363 Route 111 Ste 107 Smithtown NY 11787-4750 | |
| (631) 209-4255 | |
| (631) 693-3313 |
| Full Name | Integrated Care Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 363 Route 111 Ste 107, Smithtown, New York |
| Authorized Official Name and Position | Rose Peterson (ADMINISTRATOR) |
| Authorized Official Contact | 6312094255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Care Group Llc 363 Route 111 Ste 107a Smithtown NY 11787-4750 Ph: (631) 209-4255 | Integrated Care Group Llc 363 Route 111 Ste 107 Smithtown NY 11787-4750 Ph: (631) 209-4255 |
| NPI Number | 1154097269 |
|---|---|
| Provider Enumeration Date | 08/18/2021 |
| Last Update Date | 08/18/2021 |
| Certification Date | 08/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154097269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
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