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Organization
INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC
Active
Organization
INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC
Active
Other names
INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM EDALAT (OWNER)
(212) 371-0360
Entity
Organization
Contact information
Practice address
30 CENTRAL PARK S RM 4C, NEW YORK, NY 10019-1628
(212) 371-0360
Mailing address
30 CENTRAL PARK S RM 4C, NEW YORK, NY 10019-1628
(212) 371-0360
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
122300000X
Dentist
—
—
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
208D00000X
General Practice Physician
—
—
374U00000X
Home Health Aide
—
—
405300000X
Prevention Professional
—
—
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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