Healthcare Provider Details

I. General information

NPI: 1518307313
Provider Name (Legal Business Name): COMPLEX CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BROAD ST 815
NEW YORK NY
10004-2415
US

IV. Provider business mailing address

75 BROAD ST 815
NEW YORK NY
10004-2415
US

V. Phone/Fax

Practice location:
  • Phone: 347-761-1328
  • Fax: 718-732-2638
Mailing address:
  • Phone: 347-761-1328
  • Fax: 718-732-2638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberF337833-1
License Number StateNY

VIII. Authorized Official

Name: MS. ERIN OCONNOR
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 347-761-3286