1518307313 NPI number — COMPLEX CARE SOLUTIONS

Table of content: (NPI 1518307313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518307313 NPI number — COMPLEX CARE SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLEX CARE SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518307313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 BROAD ST
Provider Second Line Business Mailing Address:
815
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10004-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-761-1328
Provider Business Mailing Address Fax Number:
718-732-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 BROAD ST
Provider Second Line Business Practice Location Address:
815
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10004-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-761-1328
Provider Business Practice Location Address Fax Number:
718-732-2638
Provider Enumeration Date:
06/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OCONNOR
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
347-761-3286

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  F337833-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com