Healthcare Provider Details

I. General information

NPI: 1275297707
Provider Name (Legal Business Name): FLEX TO SUCCESS CLINICAL REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 10/30/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WAVERLY AVE STE 11
PATCHOGUE NY
11772-1555
US

IV. Provider business mailing address

21 GROVE DR
MASTIC NY
11950-1603
US

V. Phone/Fax

Practice location:
  • Phone: 631-618-5940
  • Fax:
Mailing address:
  • Phone: 631-618-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RAMIN ADRIAN AZARM
Title or Position: OWNER
Credential: LCSW
Phone: 631-618-5940