Basic Information
| Provider Information | |||||||||
| NPI: | 1144383258 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPREHENSIVE PSYCHIATRIC SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 OCEANA DR E APT PH2B | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112356698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187430771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2269 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112293103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183398200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHIF | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7187430771 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 201591 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.