Healthcare Provider Details

I. General information

NPI: 1003624982
Provider Name (Legal Business Name): CCM NY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 37TH ST
LONG ISLAND CITY NY
11101-1842
US

IV. Provider business mailing address

4533 37TH ST
LONG ISLAND CITY NY
11101-1842
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-1047
  • Fax:
Mailing address:
  • Phone: 718-450-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. RENAT NAYMANOV
Title or Position: PRESIDENT
Credential:
Phone: 718-450-1047