# EXCELSIOR INTEGRATED MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275081838
- **Authorized official:** DR. GEOGRE HALL M.D. (PRESIDENT)
- **Authorized official phone:** (718) 938-3188

## Contact information

- **Practice address:** 217 GRAND ST, SUITE 401, NEW YORK, NY 10013-4396
- **Practice address phone:** (212) 390-1830
- **Practice address fax:** (212) 390-8177
- **Mailing address:** 217 GRAND ST, SUITE 401, NEW YORK, NY 10013-4396
- **Mailing address phone:** (212) 390-1830
- **Mailing address fax:** (212) 390-8177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 9389049 | NY | Yes |

## Other

- **Enumeration date:** 09/13/2016
- **Last updated:** 09/13/2016