Provider Demographics
NPI:1376981639
Name:COMPLEXCARE SOLUTIONS
Entity Type:Organization
Organization Name:COMPLEXCARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-761-3286
Mailing Address - Street 1:75 BROAD ST RM 815
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-3233
Mailing Address - Country:US
Mailing Address - Phone:134-776-1328
Mailing Address - Fax:718-732-2638
Practice Address - Street 1:75 BROAD ST RM 815
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-3233
Practice Address - Country:US
Practice Address - Phone:134-776-1328
Practice Address - Fax:718-732-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016528302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization