# EAST SIDE INTEGRATIVE MEDICINE PC

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

## Provider details

- **NPI number:** 1659081461
- **Authorized official:** BENJAMIN JAMES MEDRANO (DIRECTOR)
- **Authorized official phone:** (720) 251-9215

## Contact information

- **Practice address:** 1 BARKER AVE STE 200, WHITE PLAINS, NY 10601-1523
- **Practice address phone:** (845) 422-6504
- **Mailing address:** 1 BARKER AVE STE 200, WHITE PLAINS, NY 10601-1523
- **Mailing address phone:** (845) 422-6504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | — | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/02/2022
- **Last updated:** 02/24/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 284877 | PSYCHIATRIST | NY |