Provider Demographics
NPI:1235229667
Name:FAMILY MADICAL PRACTICE P.C.
Entity Type:Organization
Organization Name:FAMILY MADICAL PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-636-8291
Mailing Address - Street 1:255 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6370
Mailing Address - Country:US
Mailing Address - Phone:718-636-8291
Mailing Address - Fax:
Practice Address - Street 1:255 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6370
Practice Address - Country:US
Practice Address - Phone:718-636-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141141261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00710494Medicaid
NY00710494Medicaid
NYCOQQ23Medicare UPIN