Provider Demographics
NPI:1588751119
Name:COMPREHENSIVE PODIATRIC CARE LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PODIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-627-5775
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-627-5775
Mailing Address - Fax:516-627-6259
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-627-5775
Practice Address - Fax:516-627-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005264-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPG6691OtherEMPIRE BCBS
NYP2577825OtherOXFORD
NY7102352OtherAETNA PPO
NYMDNYOtherAA71987
NY108081POtherHIP
NY0914058OtherAETNA HMO
NYPG6691OtherEMPIRE BCBS
NYMDNYOtherAA71987