Provider Demographics
NPI:1871644559
Name:COMPREHENSIVE PSYCHIATRIC EVALUATION PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHIATRIC EVALUATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZINAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYUBOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-614-6167
Mailing Address - Street 1:3411 GUIDER AVE
Mailing Address - Street 2:6 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5235
Mailing Address - Country:US
Mailing Address - Phone:718-614-6167
Mailing Address - Fax:
Practice Address - Street 1:135 OCEAN PKWY
Practice Address - Street 2:SUITE 1U
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2567
Practice Address - Country:US
Practice Address - Phone:718-614-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWAA891Medicare ID - Type Unspecified