Healthcare Provider Details

I. General information

NPI: 1902854565
Provider Name (Legal Business Name): COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST SUITE 1B
BOCA RATON FL
33486-2337
US

IV. Provider business mailing address

PO BOX 3026
HALLANDALE FL
33008-3026
US

V. Phone/Fax

Practice location:
  • Phone: 561-447-0090
  • Fax: 561-447-9663
Mailing address:
  • Phone: 561-447-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME 74132
License Number StateFL

VIII. Authorized Official

Name: DR. FRANK DOMINIC CIRISANO JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-447-0090