MEDICARE: COMPREHENSIVE OCEANVIEW MEDICAL CARE, 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	229585	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710042767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE OCEANVIEW MEDICAL CARE, PC

Provider Business Mailing Address
First Line	:	105 ORIENTAL BLVD # S1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4124
Country	:	US
Telephone Number	:	718-646-8100
Fax Number	:	718-646-2350

Provider Business Practice Location Address
First Line	:	2500 JOHNSON AVE APT 20M
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4946
Country	:	US
Telephone Number	:	718-581-0598
Fax Number	:	718-581-0598

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MILA YAKOBY
Credential	:	MD
Telephone Number	:	718-646-8100

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/01/2007

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