Provider Demographics
NPI:1346542818
Name:COMPLETE CARE MEDICAL OF N.Y. P.C.
Entity Type:Organization
Organization Name:COMPLETE CARE MEDICAL OF N.Y. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-894-2500
Mailing Address - Street 1:311 SAINT NICHOLAS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2296
Mailing Address - Country:US
Mailing Address - Phone:718-894-2500
Mailing Address - Fax:718-417-4535
Practice Address - Street 1:311 SAINT NICHOLAS AVE STE E
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2296
Practice Address - Country:US
Practice Address - Phone:718-894-2500
Practice Address - Fax:718-417-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947791Medicaid
NYA63694Medicare UPIN
NY00947791Medicaid