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General NPI Number Information
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NPI Number | 1346542818
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE MEDICAL OF N.Y. P.C.
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 311 SAINT NICHOLAS AVE STE E
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City | RIDGEWOOD
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State | NY
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Zip | 11385-2296
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Country | US
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Telephone | 718-894-2500
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Fax | 718-417-4535
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Provider Business Mailing Address
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Address Line | 311 SAINT NICHOLAS AVE STE E
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City | RIDGEWOOD
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State | NY
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Zip | 11385-2296
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Country | US
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Telephone | 718-894-2500
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Fax | 718-417-4535
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Authorized Official
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Title or Position | M.D.
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Name | MR. MARIANO MEDEROS
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Credential | M.D.
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Telephone | 718-894-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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