1104274901 NPI number — COMPREHENSIVE MEDICAL CARE AT 3RD AVENUE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104274901 NPI number — COMPREHENSIVE MEDICAL CARE AT 3RD AVENUE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE MEDICAL CARE AT 3RD AVENUE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104274901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4620 3RD AVE
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11220-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-492-4109
Provider Business Mailing Address Fax Number:
201-221-8255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4620 3RD AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-492-4109
Provider Business Practice Location Address Fax Number:
201-221-8255
Provider Enumeration Date:
06/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PICHARDO
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
RADHAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-492-4109

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  213773-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 213773-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com