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General NPI Number Information
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NPI Number | 1437482551
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE GYNECOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 42 1ST AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4602
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Country | US
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Telephone | 631-273-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 42 1ST AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOEL COOPER
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Credential |
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Telephone | 631-273-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 092267
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License Number State | NY
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