Provider Demographics
NPI:1710042767
Name:COMPREHENSIVE OCEANVIEW MEDICAL CARE, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE OCEANVIEW MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKOBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-646-8100
Mailing Address - Street 1:105 ORIENTAL BLVD # S1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4124
Mailing Address - Country:US
Mailing Address - Phone:718-646-8100
Mailing Address - Fax:718-646-2350
Practice Address - Street 1:2500 JOHNSON AVE APT 20M
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4946
Practice Address - Country:US
Practice Address - Phone:718-581-0598
Practice Address - Fax:718-581-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459947Medicaid
NY02459947Medicaid
NYWANM51Medicare Oscar/Certification