Provider Demographics
NPI:1942617816
Name:COMPREHENSIVE MEDICAL DIAGNOSTIC SERVICES PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL DIAGNOSTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SABAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-338-4912
Mailing Address - Street 1:70 OLD WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 OLD WESTBURY RD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1611
Practice Address - Country:US
Practice Address - Phone:646-338-4912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-12
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory