Provider Demographics
NPI:1427883446
Name:CANSPIREME MEDICAL GROUP LLC
Entity type:Organization
Organization Name:CANSPIREME MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:914-414-6264
Mailing Address - Street 1:61 W PALISADE AVE # 751
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2706
Mailing Address - Country:US
Mailing Address - Phone:973-850-9598
Mailing Address - Fax:
Practice Address - Street 1:61 W PALISADE AVE # 751
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2706
Practice Address - Country:US
Practice Address - Phone:973-850-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No302R00000XManaged Care OrganizationsHealth Maintenance Organization