Provider Demographics
NPI:1407619802
Name:INTEGRATED WALK-IN & FAMILY CARE
Entity type:Organization
Organization Name:INTEGRATED WALK-IN & FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:954-393-6996
Mailing Address - Street 1:104 RIVER EDGE RD
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1132
Mailing Address - Country:US
Mailing Address - Phone:954-393-6996
Mailing Address - Fax:
Practice Address - Street 1:104 RIVER EDGE RD
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1132
Practice Address - Country:US
Practice Address - Phone:954-393-6996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty