Healthcare Provider Details

I. General information

NPI: 1235689894
Provider Name (Legal Business Name): TAKE CONTROL OF YOUR HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 ACKERSON BLVD
BAY SHORE NY
11706-3845
US

IV. Provider business mailing address

1416 ACKERSON BLVD PO BX1248
BAY SHORE NY
11706-3845
US

V. Phone/Fax

Practice location:
  • Phone: 877-202-8346
  • Fax:
Mailing address:
  • Phone: 877-202-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET KRONEMBERG
Title or Position: TECHNICAL DIRECTOR/CEO/MANAGER
Credential:
Phone: 877-202-8346