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NPI Code Detail

MEDICARE: COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION

MEDICARE: COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
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
1261QF0400XFederally Qualified Health Center (FQHC)7000239RNY
2261QM1300XMulti-Specialty Clinic/Center
3261QC1500XCommunity Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17000239ROTHERNYOPERATING CERTIFICATE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578564001
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
Provider Business Mailing Address
First Line : 731 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10473-2631
Country : US
Telephone Number : 718-589-8324
Fax Number : 718-860-1838
Provider Business Practice Location Address
First Line : 731 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10473-2631
Country : US
Telephone Number : 718-589-8324
Fax Number : 718-860-1838
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MR. PEDRO ESPADA JR.
Credential :
Telephone Number : 718-589-2232
Provider Enumeration Date : 08/09/2005
Last Update Date : 02/28/2012

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Directions to “COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION ” Practice Location

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