NPIMap

Organization Active NPI

Complete Neurological Care PC

  • Neurology Physician
  • Forest Hills, NY
National Provider Identifier
1962775882
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
COMPLETE NEUROLOGICAL CARE PC
Practice address
11247 Queens Blvd
Ste 206
Forest Hills, NY 11375-7417
Phone
(718) 544-4200
Fax
(718) 544-4201
NPI assigned
Feb 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ellen Edgar, MDNPI 1326343625
Title
Owner
Phone
(718) 544-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

11247 Queens Blvd
Ste 206
Forest Hills, NY 11375-7417

Mailing address

1311 Brightwater Ave
Apt 18-Ij
Brooklyn, NY 11235-5962
Phone (718) 544-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120418000515 NY Part B Supplier - Clinic/Group Practice 9537320593 Receives reassigned benefits from 30 practitioners
Practice locations: Forest Hills, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

225 Broadway
Ste 705
New York, NY 10007
Phone (212) 349-2787

139 N Central Ave
Ste 3
Valley Stream, NY 11580
Phone (516) 887-0020

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1962775882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 BRIGHTWATER AVE",
            "address_2": "APT 18-IJ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355962",
            "telephone_number": "718-544-4200",
            "fax_number": "718-544-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD",
            "address_2": "STE 206",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757417",
            "telephone_number": "718-544-4200",
            "fax_number": "718-544-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE NEUROLOGICAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "EDGAR",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-544-4200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.