Healthcare Provider Details

I. General information

NPI: 1932323219
Provider Name (Legal Business Name): COMPREHENSIVE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 101ST AVE
OZONE PARK NY
11416-2500
US

IV. Provider business mailing address

9511 101ST AVE
OZONE PARK NY
11416-2500
US

V. Phone/Fax

Practice location:
  • Phone: 718-848-1171
  • Fax: 718-323-0032
Mailing address:
  • Phone: 718-848-1171
  • Fax: 718-323-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number222937
License Number StateNY

VIII. Authorized Official

Name: MS. PAULA WNUK
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 718-848-1171