Healthcare Provider Details

I. General information

NPI: 1962188938
Provider Name (Legal Business Name): COMPASS MEDICAL WELLNESS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 ROCKAWAY AVE
BROOKLYN NY
11212
US

IV. Provider business mailing address

381 ROCKAWAY AVE
BROOKLYN NY
11212
US

V. Phone/Fax

Practice location:
  • Phone: 917-297-8603
  • Fax:
Mailing address:
  • Phone: 917-297-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SEYED MORTEZA MAHMOUDI
Title or Position: MD
Credential: MD
Phone: 917-297-8603