MEDICARE: COMPREHENSIVE MEDICAL CARE SERVICE, PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1619403177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL CARE SERVICE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1422
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0012
Country	:	US
Telephone Number	:	347-240-8632
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 SAINT NICHOLAS AVE
Second Line	:	GROUND FL
City	:	BROOKLYN
State	:	NY
Zip	:	11237-5430
Country	:	US
Telephone Number	:	347-240-8632
Fax Number	:

Authorized Official
Title or Position	:	STAFF
Name	:	BIBI ISHMAEL
Credential	:
Telephone Number	:	347-240-8632

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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