MEDICARE: COMPREHENSIVE MEDICAL ASSIST P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	249224	NY

General Provider Information

NPI Number	:	1194172890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL ASSIST P.C.

Provider Business Mailing Address
First Line	:	PO BOX 747460
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-7460
Country	:	US
Telephone Number	:	516-441-7625
Fax Number	:	516-441-7625

Provider Business Practice Location Address
First Line	:	11 GRACE AVE
Second Line	:	SUITE 204
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2446
Country	:	US
Telephone Number	:	516-654-5551
Fax Number	:	516-441-7625

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. BORIS A KHAIMOV
Credential	:	D.O.
Telephone Number	:	516-654-5551

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	09/12/2016

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