Provider Demographics
NPI:1386000644
Name:COMPERHENSIVE PROMARY FAMILY MEDICAL CARE OF NY PLLC
Entity Type:Organization
Organization Name:COMPERHENSIVE PROMARY FAMILY MEDICAL CARE OF NY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHIMIRAD
Authorized Official - Suffix:
Authorized Official - Credentials:CDN
Authorized Official - Phone:917-794-9175
Mailing Address - Street 1:1319 CORNAGA AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1319 CORNAGA AVE FL 1
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5004
Practice Address - Country:US
Practice Address - Phone:347-526-6968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital