Integrative Mind Body Dental Telehealth LLC

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

Legal business name

INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC

Doing business as

Integrative Mind Body Dental Telehealth LLC

Practice address

30 Central Park S RM 4C
New York, NY 10019-1628

Phone

(212) 371-0360

NPI assigned

Jul 27, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Maryam EdalatNPI 1487828349

Title

Owner

Phone

(212) 371-0360

Specialties & licenses 9

Addresses

Other names 1

• INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maryam Edalat, D.D.S.

  • Dentist
  • New York, NY
  • NPI 1487828349
  NPD Authorized official

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1942819834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S RM 4C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-371-0360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S RM 4C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-371-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "EDALAT",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-371-0360",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRATIVE MIND BODY DENTAL TELEHEALTH LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nutrition Education Nutritionist in New York, NY
• Providers in New York, NY by specialty
• Nutrition Education Nutritionist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; 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.