Provider Demographics
NPI:1386191203
Name:COMPREHENSIVE PODIATRIC FOOT CARE PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PODIATRIC FOOT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMENIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-806-1434
Mailing Address - Street 1:65-11 BOOTH STREET, SUITE 1C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4184
Mailing Address - Country:US
Mailing Address - Phone:718-674-6222
Mailing Address - Fax:718-228-5272
Practice Address - Street 1:88-34 161TH STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4040
Practice Address - Country:US
Practice Address - Phone:718-674-6222
Practice Address - Fax:718-228-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006563213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty