Provider Demographics
NPI:1619403177
Name:COMPREHENSIVE MEDICAL CARE SERVICE, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:BIBI
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-240-8632
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0012
Mailing Address - Country:US
Mailing Address - Phone:347-240-8632
Mailing Address - Fax:
Practice Address - Street 1:260 SAINT NICHOLAS AVE
Practice Address - Street 2:GROUND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5430
Practice Address - Country:US
Practice Address - Phone:347-240-8632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty