Provider Demographics
NPI:1528273661
Name:SERAPHIM MEDICAL MANAGEMENT, LLC
Entity type:Organization
Organization Name:SERAPHIM MEDICAL MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:718-238-2242
Mailing Address - Street 1:376 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5808
Mailing Address - Country:US
Mailing Address - Phone:718-238-2242
Mailing Address - Fax:718-238-7288
Practice Address - Street 1:376 91ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5808
Practice Address - Country:US
Practice Address - Phone:718-238-2242
Practice Address - Fax:718-238-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026634-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty