| Eastern Comprehensive Medical Services, P.c. | |
|
196 Canal Street, Fl3 New York NY 10013-4562 | |
| (212) 227-6500 | |
| (212) 889-4987 |
| Full Name | Eastern Comprehensive Medical Services, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 196 Canal Street, Fl3, New York, New York |
| Authorized Official Name and Position | Xiao-ke Gao (PRESIDENT) |
| Authorized Official Contact | 2122276500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Comprehensive Medical Services, P.c. 106 Sheephill Road Riverside CT 06878-1120 Ph: (212) 227-6500 | Eastern Comprehensive Medical Services, P.c. 196 Canal Street, Fl3 New York NY 10013-4562 Ph: (212) 227-6500 |
| NPI Number | 1396791752 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 07/01/2020 |
| Certification Date | 07/01/2020 |
| Medicare PECOS PAC ID | 7810942133 |
|---|---|
| Medicare Enrollment ID | O20050318000599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396791752 | NPI | - | NPPES |
| 018224444 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 204338 (New York) | Primary |
| Provider Name | Xiao-ke Gao |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730136607 PECOS PAC ID: 2860470515 Enrollment ID: I20040709000936 |
| Provider Name | Eli Fontanilla |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568686426 PECOS PAC ID: 6608951017 Enrollment ID: I20080310000531 |
| Provider Name | Hyejin Cho |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386214302 PECOS PAC ID: 6406203462 Enrollment ID: I20231113002249 |
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