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General NPI Number Information
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NPI Number | 1528273661
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Entity Type | Organization
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Legal Business Name | SERAPHIM MEDICAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 376 91ST ST
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City | BROOKLYN
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State | NY
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Zip | 11209-5808
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Country | US
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Telephone | 718-238-2242
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Fax | 718-238-7288
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Provider Business Mailing Address
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Address Line | 376 91ST ST
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City | BROOKLYN
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State | NY
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Zip | 11209-5808
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Country | US
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Telephone | 718-238-2242
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Fax | 718-238-7288
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JAMES VINCENT COOPER
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Credential | MSPT
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Telephone | 718-238-2242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 026634-1
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License Number State | NY
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