Provider Demographics
NPI:1578011177
Name:COMPREHENSIVE MEDICAL ASSIST P.C.
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL ASSIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-654-5551
Mailing Address - Street 1:PO BOX 747460
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-7460
Mailing Address - Country:US
Mailing Address - Phone:516-441-7625
Mailing Address - Fax:516-441-7625
Practice Address - Street 1:5 RUDYARD DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3768
Practice Address - Country:US
Practice Address - Phone:732-479-2764
Practice Address - Fax:732-313-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09860800363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty