Provider Demographics
NPI:1073546354
Name:CENTER FOR COMPREHENSIVE HEALTH PRACTICE INC
Entity Type:Organization
Organization Name:CENTER FOR COMPREHENSIVE HEALTH PRACTICE INC
Other - Org Name:CENTER FOR COMPREHENSIVE HEALTH PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-360-7893
Mailing Address - Street 1:35 E 110TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-0354
Mailing Address - Country:US
Mailing Address - Phone:212-360-7893
Mailing Address - Fax:212-937-0928
Practice Address - Street 1:35 E 110TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-0354
Practice Address - Country:US
Practice Address - Phone:212-360-7893
Practice Address - Fax:212-937-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01148714Medicaid
NY01148714Medicaid