Healthcare Provider Details

I. General information

NPI: 1578564001
Provider Name (Legal Business Name): COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

IV. Provider business mailing address

731 WHITE PLAINS RD
BRONX NY
10473-2631
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-8324
  • Fax: 718-860-1838
Mailing address:
  • Phone: 718-589-8324
  • Fax: 718-860-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number7000239R
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO ESPADA JR.
Title or Position: PRESIDENT & CEO
Credential:
Phone: 718-589-2232