Healthcare Provider Details

I. General information

NPI: 1699106997
Provider Name (Legal Business Name): COMPASS MEDICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MADISON AVE SUITE 1501
NEW YORK NY
10017-1110
US

IV. Provider business mailing address

425 MADISON AVE SUITE 1502
NEW YORK NY
10017-1110
US

V. Phone/Fax

Practice location:
  • Phone: 212-969-1899
  • Fax: 212-969-1898
Mailing address:
  • Phone: 212-969-1899
  • Fax: 212-969-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number240287
License Number StateNY

VIII. Authorized Official

Name: DR. GLENN ANDREW BROTTMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 212-969-1899