MEDICARE: CORE HEALTH CCM CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	2083P0901X	Public Health & General Preventive Medicine Physician

General Provider Information

NPI Number	:	1184370884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE HEALTH CCM CORP

Provider Business Mailing Address
First Line	:	3272 STEINWAY ST STE 302
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4183
Country	:	US
Telephone Number	:	929-424-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3272 STEINWAY ST STE 302
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4183
Country	:	US
Telephone Number	:	929-424-3400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KATRINA A GUALBERTO
Credential	:
Telephone Number	:	929-424-3400

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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Directions to “CORE HEALTH CCM CORP ” Practice Location

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