Provider Demographics
NPI:1518307313
Name:COMPLEX CARE SOLUTIONS
Entity Type:Organization
Organization Name:COMPLEX CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-761-3286
Mailing Address - Street 1:75 BROAD ST
Mailing Address - Street 2:815
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2415
Mailing Address - Country:US
Mailing Address - Phone:347-761-1328
Mailing Address - Fax:718-732-2638
Practice Address - Street 1:75 BROAD ST
Practice Address - Street 2:815
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2415
Practice Address - Country:US
Practice Address - Phone:347-761-1328
Practice Address - Fax:718-732-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337833-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization