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General NPI Number Information
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NPI Number | 1942501457
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Entity Type | Organization
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Legal Business Name | COMPOS MENTIS MEDICAL PC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1430 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4300
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Country | US
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Telephone | 718-795-8498
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Fax | 718-876-7013
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Provider Business Mailing Address
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Address Line | 211 CORBIN PL
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City | BROOKLYN
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State | NY
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Zip | 11235-4901
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Country | US
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Telephone | 718-795-8498
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Fax | 718-976-7013
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX MIKHELSON
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Credential | M.D
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Telephone | 718-795-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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