Provider Demographics
NPI:1548560527
Name:COMPLETE HEALTH MEDICAL P.C.
Entity Type:Organization
Organization Name:COMPLETE HEALTH MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:KANAKOUDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DC,MS
Authorized Official - Phone:631-751-5700
Mailing Address - Street 1:3400 NESCONSET HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3339
Mailing Address - Country:US
Mailing Address - Phone:631-751-5700
Mailing Address - Fax:631-444-0193
Practice Address - Street 1:3400 NESCONSET HWY STE 102
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-751-5700
Practice Address - Fax:631-444-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010895111N00000X
111NS0005X
NY257261207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty