Basic Information
| Provider Information | |||||||||
| NPI: | 1043484769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CCF NEW YORK MEDICAL SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 SCIENCE PARK DR # AC321 | ||||||||
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| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441227316 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
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| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CAO & CONTROLLER - CCF | ||||||||
| AuthorizedOfficialTelephone: | 2164458990 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLEVELAND CLINIC FOUNDATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist |
No ID Information.