Provider Demographics
NPI:1720383078
Name:COMPREHENSIVE CARE CENTERS OF QUEENS
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE CENTERS OF QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-225-2396
Mailing Address - Street 1:101-10 QUEENS BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-830-0533
Mailing Address - Fax:
Practice Address - Street 1:101-10 QUEENS BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-830-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherSOCIAL ADULT DAY CARE PROGRAM