MEDICARE: COMPASSIONATE COMMUNITY PHYSICIANS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1003441429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COMMUNITY PHYSICIANS PC

Provider Business Mailing Address
First Line	:	6861 YELLOWSTONE BLVD APT 116
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6861 YELLOWSTONE BLVD APT 116
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3371
Country	:	US
Telephone Number	:	347-689-8880
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	ILYA KLEYN
Credential	:	MD
Telephone Number	:	347-689-8880

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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