Provider Demographics
NPI:1285104257
Name:ISLAND COMPREHENSIVE CARE INC.
Entity type:Organization
Organization Name:ISLAND COMPREHENSIVE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGLALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-886-2844
Mailing Address - Street 1:6144 ROUTE 25A STE 13
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2008
Mailing Address - Country:US
Mailing Address - Phone:917-225-2165
Mailing Address - Fax:
Practice Address - Street 1:6144 ROUTE 25A STE 13
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2008
Practice Address - Country:US
Practice Address - Phone:917-225-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty