MEDICARE: COMPREHENSIVE KIDS

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	252Y00000X	Early Intervention Provider Agency	100710851	NY

General Provider Information

NPI Number	:	1184932980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE KIDS

Provider Business Mailing Address
First Line	:	444 EAST 86TH STREET
Second Line	:	APT 6B
City	:	NEW YORK CITY
State	:	NY
Zip	:	10028-6480
Country	:	US
Telephone Number	:	646-657-0430
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 EAST 86TH STREET
Second Line	:	APT 6B
City	:	NEW YORK CITY
State	:	NY
Zip	:	10028-6480
Country	:	US
Telephone Number	:	646-657-0430
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ROBERTA KRAMER
Credential	:
Telephone Number	:	212-566-8855

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	09/15/2010

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