MEDICARE: SERAPHIM MEDICAL MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	026634-1	NY

General Provider Information

NPI Number	:	1528273661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERAPHIM MEDICAL MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	376 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5808
Country	:	US
Telephone Number	:	718-238-2242
Fax Number	:	718-238-7288

Provider Business Practice Location Address
First Line	:	376 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5808
Country	:	US
Telephone Number	:	718-238-2242
Fax Number	:	718-238-7288

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. JAMES VINCENT COOPER
Credential	:	MSPT
Telephone Number	:	718-238-2242

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/20/2007

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