Healthcare Provider Details

I. General information

NPI: 1740629062
Provider Name (Legal Business Name): TAKE CONTROL OF YOUR HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 04/11/2014
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 BOX 1248
BAY SHORE NY
11706-3845
US

V. Phone/Fax

Practice location:
  • Phone: 631-463-3747
  • Fax: 631-968-2401
Mailing address:
  • Phone: 631-463-3747
  • Fax: 631-968-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number00081464
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET KRONEMBERG
Title or Position: REGISTER VASCULAR SPECIALIST
Credential: RVS
Phone: 631-463-3747