Provider Demographics
NPI:1700183811
Name:COMPREHENSIVE CARE CENTERS OF STATEN ISLAND
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE CENTERS OF STATEN ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-225-2396
Mailing Address - Street 1:1828 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:347-225-2396
Mailing Address - Fax:
Practice Address - Street 1:1828 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:347-225-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management