Provider Demographics
NPI:1558357442
Name:COMPREHENSIVE BEHAVIORAL MEDICAL CARE PC
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHRISPHONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-249-2765
Mailing Address - Street 1:750 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3642
Mailing Address - Country:US
Mailing Address - Phone:631-249-2765
Mailing Address - Fax:631-249-3617
Practice Address - Street 1:750 FULTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3642
Practice Address - Country:US
Practice Address - Phone:631-249-2765
Practice Address - Fax:631-249-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD641Medicare ID - Type Unspecified