Provider Demographics
NPI:1750430609
Name:INTEGRATED MEDICAL HEALTH CARE PC
Entity type:Organization
Organization Name:INTEGRATED MEDICAL HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-366-3334
Mailing Address - Street 1:624 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2821
Mailing Address - Country:US
Mailing Address - Phone:631-366-3334
Mailing Address - Fax:631-366-3233
Practice Address - Street 1:624 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2821
Practice Address - Country:US
Practice Address - Phone:631-366-3334
Practice Address - Fax:631-366-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206669261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01797382Medicaid
NY6138162-007OtherCIGNA HEALTHCARE
NYAA70462OtherMDNY
NYP2370468OtherOXFORD
NYOD2081OtherEMPIRE BCBS
NY477164OtherPHCS
NY2007635OtherUNITED HEALTHCARE
NY5904677OtherGHI - GROUP HEALTH INC
NYSF-0002620OtherSELECT PRO
NY6138162-007OtherCIGNA HEALTHCARE
NYSF-0002620OtherSELECT PRO