1538473723 NPI number — COMPLETE MEDICAL NY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538473723 NPI number — COMPLETE MEDICAL NY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE MEDICAL NY, PC
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:
1538473723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13876 QUEENS BLVD
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
BRIARWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11435-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-850-6345
Provider Business Mailing Address Fax Number:
718-559-4895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13876 QUEENS BLVD
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BRIARWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11435-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-850-6345
Provider Business Practice Location Address Fax Number:
718-559-4895
Provider Enumeration Date:
07/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PRACTICE
Authorized Official Telephone Number:
718-850-6345

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  244295 , 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)

  • Identifier: 03133740 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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