Healthcare Provider Details

I. General information

NPI: 1346557964
Provider Name (Legal Business Name): NEW YORK COMPREHENSIVE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-25 31ST STREET 2ND FLOOR
ASTORIA NY
11105
US

IV. Provider business mailing address

PO BOX 740017
FLUSHING NY
11374-0017
US

V. Phone/Fax

Practice location:
  • Phone: 347-417-9094
  • Fax: 718-732-2434
Mailing address:
  • Phone: 347-417-9094
  • Fax: 718-732-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA DALEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 347-417-9094