| Comprehensive Family Medical Practice, Pc | |
|
21008 35th Ave Bayside NY 11361-1431 | |
| (718) 229-4090 | |
| (866) 457-6793 |
| Full Name | Comprehensive Family Medical Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 21008 35th Ave, Bayside, New York |
| Authorized Official Name and Position | Jia Park (OWNER) |
| Authorized Official Contact | 7182294090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Comprehensive Family Medical Practice, Pc 21008 35th Ave Bayside NY 11361-1431 Ph: (718) 229-4090 | Comprehensive Family Medical Practice, Pc 21008 35th Ave Bayside NY 11361-1431 Ph: (718) 229-4090 |
| NPI Number | 1194023135 |
|---|---|
| Provider Enumeration Date | 02/28/2011 |
| Last Update Date | 03/19/2021 |
| Certification Date | 03/19/2021 |
| Medicare PECOS PAC ID | 9032389275 |
|---|---|
| Medicare Enrollment ID | O20110826000219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194023135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 174400000X | Specialist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jia Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588774921 PECOS PAC ID: 0840299343 Enrollment ID: I20070117000269 |
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