Healthcare Provider Details

I. General information

NPI: 1326350265
Provider Name (Legal Business Name): COMPLETE MEDICAL NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13876 QUEENS BLVD 1ST FLOOR
BRIARWOOD NY
11435-2930
US

IV. Provider business mailing address

13876 QUEENS BLVD 1ST FLOOR
BRIARWOOD NY
11435-2930
US

V. Phone/Fax

Practice location:
  • Phone: 718-850-6345
  • Fax: 718-559-4895
Mailing address:
  • Phone: 718-850-6345
  • Fax: 718-559-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number244295
License Number StateNY

VIII. Authorized Official

Name: LANA IZRAILOV
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-850-6345