Provider Demographics
NPI:1669582060
Name:COMPREHENSIVE FAMILY PODIATRY
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONG
Authorized Official - Middle Name:KI
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,
Authorized Official - Phone:212-686-5040
Mailing Address - Street 1:422 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4002
Mailing Address - Country:US
Mailing Address - Phone:212-686-5040
Mailing Address - Fax:212-686-5320
Practice Address - Street 1:422 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4002
Practice Address - Country:US
Practice Address - Phone:212-686-5040
Practice Address - Fax:212-686-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005865213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPPWV31Medicare PIN
CTU96330Medicare UPIN
NY6269740001Medicare NSC
CT480000955Medicare ID - Type Unspecified
NYPH8481Medicare ID - Type Unspecified