| Organization Name: | INTEGRATED HEALTH MEDICAL SYSTEM PC |
| NPI Number: | 1053583310 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOLLY FANTASIA (REGISTARED AGENT) |
| Mailing Address: | 1930 Route 70 E Suite I 48 Cherry Hill |
| State: | NJ US |
| Postal Code: | 080032150 |
| Phone Number: | 8564890505 |
| Fax Number: | 8564890435 |
| NPI Enumeration Date: | 03/27/2008 |
| NPI Last Update Date: | 03/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |