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
1	261QF0400X	Federally Qualified Health Center (FQHC)	7000239R	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	:	1821252743
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	:	165 E BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-4104
Country	:	US
Telephone Number	:	718-539-0003
Fax Number	:	718-569-9054

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	PEDRO ESPADA
Credential	:
Telephone Number	:	718-589-2232

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	06/21/2018

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Directions to “COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION ” Practice Location

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