Integra Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA07654700 Issued in NJ

Legal business name

INTEGRA MEDICAL GROUP LLC

Practice address

1124 E Ridgewood Ave
Suite 103
Ridgewood, NJ 07450-3915

Phone

(201) 447-7348

NPI assigned

Sep 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ladan Bahrampour

Title

MD

Phone

(201) 447-7348

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1720361884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074170741",
            "telephone_number": "973-476-7527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 E RIDGEWOOD AVE",
            "address_2": "SUITE 103",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503915",
            "telephone_number": "201-447-7348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "BAHRAMPOUR",
        "authorized_official_first_name": "LADAN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "201-447-7348"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07654700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.