Provider Demographics
NPI:1902854565
Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Entity Type:Organization
Organization Name:COMPREHENSIVE GYNECOLOGIC ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:CIRISANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-447-0090
Mailing Address - Street 1:PO BOX 3026
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-3026
Mailing Address - Country:US
Mailing Address - Phone:561-447-0090
Mailing Address - Fax:
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-447-0090
Practice Address - Fax:561-447-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 74132207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1683CMedicare NSC