Provider Demographics
NPI:1932323219
Name:COMPREHENSIVE PEDIATRICS
Entity Type:Organization
Organization Name:COMPREHENSIVE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:WNUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-848-1171
Mailing Address - Street 1:9511 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2500
Mailing Address - Country:US
Mailing Address - Phone:718-848-1171
Mailing Address - Fax:718-323-0032
Practice Address - Street 1:9511 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2500
Practice Address - Country:US
Practice Address - Phone:718-848-1171
Practice Address - Fax:718-323-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1174504690 NPIOtherDR. FABIO MEHRGUT
NY02367471Medicaid
NY1477535300 NPIOtherDR. ELIZABETH AVARICIO