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General NPI Number Information
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NPI Number | 1033588140
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Entity Type | Organization
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Legal Business Name | MADISON SQUARE COMPREHENSIVE MEDICAL CARE, PLLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 147 E 26TH ST
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City | NEW YORK
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State | NY
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Zip | 10010-1868
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Country | US
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Telephone | 212-533-2400
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Fax | 212-533-6607
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Provider Business Mailing Address
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Address Line | 121 W 27TH ST STE 504
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City | NEW YORK
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State | NY
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Zip | 10001-6207
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Country | US
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Telephone | 212-533-2400
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Fax | 212-533-6607
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SHAWN KHODADADIAN
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Credential | MD
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Telephone | 212-533-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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