Healthcare Provider Details

I. General information

NPI: 1326506502
Provider Name (Legal Business Name): KREDIT KONCEPTS FINANCIAL SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CASTLE HILL AVE
BRONX NY
10462-4830
US

IV. Provider business mailing address

1175 CASTLE HILL AVE
BRONX NY
10462-4830
US

V. Phone/Fax

Practice location:
  • Phone: 646-528-9846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MASSIAH
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 646-528-9846