MEDICARE: CONVENIENT MONITORING GROUP 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	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861117913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVENIENT MONITORING GROUP LLC

Provider Business Mailing Address
First Line	:	169 FRANKLIN ST
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2220
Country	:	US
Telephone Number	:	347-730-9448
Fax Number	:	212-888-6024

Provider Business Practice Location Address
First Line	:	1755 YORK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6849
Country	:	US
Telephone Number	:	347-730-9448
Fax Number	:	212-888-6024

Authorized Official
Title or Position	:	PROVIDER
Name	:	BABACAR CISSE
Credential	:	MD
Telephone Number	:	646-705-1850

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	04/22/2023

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