Provider Demographics
NPI:1154435576
Name:COMPREHENSIVE ISLAND MEDICAL CARE LLC
Entity type:Organization
Organization Name:COMPREHENSIVE ISLAND MEDICAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-486-4834
Mailing Address - Street 1:6080 JERICHO TPKE STE 205
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2808
Mailing Address - Country:US
Mailing Address - Phone:631-486-4834
Mailing Address - Fax:631-486-5029
Practice Address - Street 1:6080 JERICHO TPKE STE 205
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2808
Practice Address - Country:US
Practice Address - Phone:631-486-4834
Practice Address - Fax:631-486-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08V22MW181Medicare PIN
G81186Medicare UPIN
G81186Medicare UPIN