Basic Information
| Provider Information | |||||||||
| NPI: | 1881263408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE OB/GYN HEALTHCARE,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168224600 | ||||||||
| FaxNumber: | 5168224602 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168224600 | ||||||||
| FaxNumber: | 5168224602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2021 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | KOTHARI | ||||||||
| AuthorizedOfficialFirstName: | ANU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5168224600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.