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General NPI Number Information
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NPI Number | 1194172890
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MEDICAL ASSIST P.C.
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 11 GRACE AVE SUITE 204
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City | GREAT NECK
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State | NY
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Zip | 11021-2446
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Country | US
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Telephone | 516-654-5551
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Fax | 516-441-7625
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Provider Business Mailing Address
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Address Line | PO BOX 747460
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City | REGO PARK
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State | NY
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Zip | 11374-7460
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Country | US
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Telephone | 516-441-7625
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Fax | 516-441-7625
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BORIS A KHAIMOV
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Credential | D.O.
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Telephone | 516-654-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 249224
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License Number State | NY
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