MEDICARE: CHRONIC CARE SPECIALISTS OF OHIO 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1588511646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRONIC CARE SPECIALISTS OF OHIO LLC

Provider Business Mailing Address
First Line	:	1999 CEDARBRIDGE AVE STE 1A
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-7048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 GATEWAY
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-2447
Country	:	US
Telephone Number	:	212-734-6621
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AKIVA WALDMAN
Credential	:
Telephone Number	:	848-223-8496

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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