Provider Demographics
NPI:1376044057
Name:COMPERHENSIVE CHILD CARE PEDIATRICS P.C.
Entity Type:Organization
Organization Name:COMPERHENSIVE CHILD CARE PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-951-8918
Mailing Address - Street 1:322 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5602
Mailing Address - Country:US
Mailing Address - Phone:347-968-5637
Mailing Address - Fax:
Practice Address - Street 1:5908 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4071
Practice Address - Country:US
Practice Address - Phone:347-951-8918
Practice Address - Fax:877-991-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03950718Medicaid