Comprehensive Ny Professional Medical PLLC
Organization Active NPI Internal Medicine Physician · Wawarsing, NY
NPI 1750157111 · NPPES record last updated Mar 5, 2024
Key facts
- NPI
- 1750157111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- COMPREHENSIVE NY PROFESSIONAL MEDICAL PLLC
- Practice address
- 7256 Route 209
Wawarsing, NY 12489-2016 - Phone
- (845) 728-8872
- NPI assigned
- Nov 28, 2023
- Organization subpart
- No
Authorized official
- Name
- Dr. Lev Grinman, MD
- Title
- Co-Owner
- Phone
- (646) 673-1660
Practitioners 4
-
Shante Brady, FNP
-
Itay Keshet, MD
-
Fleeta Burgess, APN-BC
-
Wright Gillies, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240402003121 | NY | Part B Supplier - Clinic/Group Practice | 1153769708 |
Receives reassigned benefits from 3 practitioners Practice locations: Montgomery, NY; Wawarsing, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
7256 Route 209
Wawarsing, NY 12489-2016
Mailing address
4 Legends Cir
Melville, NY 11747-5302
Phone (646) 673-1666
Other names
- Family Medcare
Other providers in Wawarsing, NY
All providers in Wawarsing, NY · Internal Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.