Provider Demographics
NPI:1972137537
Name:FREEDOM CARE IPA, OOC
Entity Type:Organization
Organization Name:FREEDOM CARE IPA, OOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-989-9710
Mailing Address - Street 1:1979 MARCUS AVE STE C115
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1126
Mailing Address - Country:US
Mailing Address - Phone:718-989-9710
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE STE C115
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1126
Practice Address - Country:US
Practice Address - Phone:718-989-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical InformaticsGroup - Multi-Specialty