Basic Information
| Provider Information | |||||||||
| NPI: | 1043588536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND COMPREHENSIVE MEDICAL CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 DEER PARK AVE | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117295208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316670388 | ||||||||
| FaxNumber: | 6319687705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1231 DEER PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117033104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316670388 | ||||||||
| FaxNumber: | 6319687705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | NOORI | ||||||||
| AuthorizedOfficialFirstName: | KHALID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6316670388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2416121 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.