Healthcare Provider Details

I. General information

NPI: 1235456864
Provider Name (Legal Business Name): COMPREHENSIVE HEALTHCARE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 CLYDE ST APT 7H
FOREST HILLS NY
11375-4006
US

IV. Provider business mailing address

6730 CLYDE ST APT 7H
FOREST HILLS NY
11375-4006
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-7217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2380025
License Number StateNY

VIII. Authorized Official

Name: DR. TIMUR HANAN
Title or Position: PRINCIPAL
Credential: MD
Phone: 917-538-7217