MEDICARE: UNITED COMPREHENSIVE CARE, LTD

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	261Q00000X	Clinic/Center		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515203R	OTHER	NY	NYS DOH OPERATING CERTIFICATE

General Provider Information

NPI Number	:	1841554144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COMPREHENSIVE CARE, LTD

Provider Business Mailing Address
First Line	:	170 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-473-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 OLD COUNTRY RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2198
Country	:	US
Telephone Number	:	631-473-7100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KENNETH GAUL
Credential	:
Telephone Number	:	631-473-7100

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	05/20/2015

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