Provider Demographics
NPI:1184899528
Name:COMPREHENSIVE PEDIATRICS PC
Entity type:Organization
Organization Name:COMPREHENSIVE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FARACI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-256-1057
Mailing Address - Street 1:1407 WEST 6TH STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-256-1057
Mailing Address - Fax:718-256-4912
Practice Address - Street 1:1407 WEST 6TH STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-256-1057
Practice Address - Fax:718-256-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1591971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF04105310Medicaid
NYNF04105310Medicaid