Provider Demographics
NPI:1184972150
Name:COMPREHENSIVE METRO MEDICINE PC
Entity type:Organization
Organization Name:COMPREHENSIVE METRO MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-687-2273
Mailing Address - Street 1:779 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4440
Mailing Address - Country:US
Mailing Address - Phone:347-687-2273
Mailing Address - Fax:908-636-2565
Practice Address - Street 1:779 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4440
Practice Address - Country:US
Practice Address - Phone:347-687-2273
Practice Address - Fax:908-636-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty