Healthcare Provider Details

I. General information

NPI: 1639344609
Provider Name (Legal Business Name): COMPLETE CARDIOVASCULAR CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7803 4TH AVE
BROOKLYN NY
11209-3701
US

IV. Provider business mailing address

7803 4TH AVE
BROOKLYN NY
11209-3701
US

V. Phone/Fax

Practice location:
  • Phone: 718-491-4949
  • Fax: 718-491-4929
Mailing address:
  • Phone: 718-491-4949
  • Fax: 718-491-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. SPYROS P KOKOLIS
Title or Position: EXECUTIVE
Credential: MD
Phone: 718-491-4949