Organization
INTEGRATED CARE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE PETERSON NPP (ADMINISTRATOR)
(631) 209-4255
Entity
Organization
Contact information
Practice address
363 ROUTE 111 STE 107, SMITHTOWN, NY 11787-4750
(631) 209-4255
(631) 693-3313
Mailing address
363 ROUTE 111 STE 107A, SMITHTOWN, NY 11787-4750
(631) 209-4255
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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