# INTEGRA MEDICAL GROUP LLC

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

## Provider details

- **NPI number:** 1720361884
- **Authorized official:** LADAN BAHRAMPOUR (MD)
- **Authorized official phone:** (201) 447-7348

## Contact information

- **Practice address:** 1124 E RIDGEWOOD AVE, SUITE 103, RIDGEWOOD, NJ 07450-3915
- **Practice address phone:** (201) 447-7348
- **Mailing address:** PO BOX 741, FRANKLIN LAKES, NJ 07417-0741
- **Mailing address phone:** (973) 476-7527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA07654700 | NJ | Yes |

## Other

- **Enumeration date:** 09/26/2011
- **Last updated:** 11/03/2014