Basic Information
| Provider Information | |||||||||
| NPI: | 1548644255 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR COMPREHENSIVE HEALTH PRACTICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 2ND AVE | ||||||||
| Address2: | FLOOR 9 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123607875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 2ND AVE | ||||||||
| Address2: | FLOOR 9 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123607875 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | PORTER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2123607767 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.