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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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