Provider Demographics
NPI:1326178765
Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Entity Type:Organization
Organization Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:CIRISANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-670-1122
Mailing Address - Street 1:PO BOX 7957
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-7957
Mailing Address - Country:US
Mailing Address - Phone:305-788-0705
Mailing Address - Fax:561-447-9663
Practice Address - Street 1:5130 LINTON BLVD STE A-1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:405-788-0705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74132207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1683CMedicare PIN