Healthcare Provider Details

I. General information

NPI: 1558357442
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FULTON ST
FARMINGDALE NY
11735-3642
US

IV. Provider business mailing address

750 FULTON ST
FARMINGDALE NY
11735-3642
US

V. Phone/Fax

Practice location:
  • Phone: 631-249-2765
  • Fax: 631-249-3617
Mailing address:
  • Phone: 631-249-2765
  • Fax: 631-249-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN A CHRISPHONTE
Title or Position: SECRETARY
Credential: MD
Phone: 631-249-2765