Provider Demographics
NPI:1609287812
Name:COMPREHENSIVE OB/GYN CARE, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE OB/GYN CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-926-4101
Mailing Address - Street 1:591 HANCOCK ST
Mailing Address - Street 2:APT. # 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1108
Mailing Address - Country:US
Mailing Address - Phone:347-926-4101
Mailing Address - Fax:347-619-9031
Practice Address - Street 1:252 BEACH 14TH ST
Practice Address - Street 2:SUITE C1
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5555
Practice Address - Country:US
Practice Address - Phone:347-926-4101
Practice Address - Fax:347-619-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213092207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6514UJMedicare PIN