Provider Demographics
NPI:1851737209
Name:COMPLETE WELLNESS MEDICAL PC
Entity Type:Organization
Organization Name:COMPLETE WELLNESS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-737-9000
Mailing Address - Street 1:551 MADISON AVE STE 1201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3390
Mailing Address - Country:US
Mailing Address - Phone:212-737-0000
Mailing Address - Fax:212-223-5700
Practice Address - Street 1:551 MADISON AVE STE 1201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3390
Practice Address - Country:US
Practice Address - Phone:212-737-0000
Practice Address - Fax:212-223-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX04080-1111N00000X
NY011670X111N00000X
NY256120207Q00000X
NY261708208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty