Basic Information
| Provider Information | |||||||||
| NPI: | 1558899989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE FAMILY MEDICAL CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 488 E JERICHO TPKE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117467328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314702572 | ||||||||
| FaxNumber: | 6317592921 | ||||||||
| Practice Location | |||||||||
| Address1: | 488 E JERICHO TPKE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117467328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314702572 | ||||||||
| FaxNumber: | 6317592921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LLANOS | ||||||||
| AuthorizedOfficialFirstName: | EVELYN | ||||||||
| AuthorizedOfficialMiddleName: | ALTAGRACIA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 6314702572 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 238105-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.