Provider Demographics
NPI:1699065003
Name:COMPREHENSIVE PRIMARY FAMILY MEDICAL CARE OF NY, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE PRIMARY FAMILY MEDICAL CARE OF NY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-327-2101
Mailing Address - Street 1:1319 CORNAGA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5004
Mailing Address - Country:US
Mailing Address - Phone:718-327-2101
Mailing Address - Fax:718-471-3863
Practice Address - Street 1:1319 CORNAGA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5004
Practice Address - Country:US
Practice Address - Phone:718-327-2101
Practice Address - Fax:718-471-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231883261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI18066Medicare UPIN