Provider Demographics
NPI:1053583310
Name:INTEGRATED HEALTH MEDICAL SYSTEM PC
Entity type:Organization
Organization Name:INTEGRATED HEALTH MEDICAL SYSTEM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTARED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTASIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-489-0505
Mailing Address - Street 1:1930 ROUTE 70 E
Mailing Address - Street 2:SUITE I 48
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-489-0505
Mailing Address - Fax:856-489-0435
Practice Address - Street 1:1930 ROUTE 70 E
Practice Address - Street 2:SUITE I 48
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-489-0505
Practice Address - Fax:856-489-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty