Provider Demographics
NPI:1033588140
Name:MADISON SQUARE COMPREHENSIVE MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:MADISON SQUARE COMPREHENSIVE MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODADADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-533-2400
Mailing Address - Street 1:121 W 27TH ST STE 504
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6207
Mailing Address - Country:US
Mailing Address - Phone:212-533-2400
Mailing Address - Fax:212-533-6607
Practice Address - Street 1:147 E 26TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1868
Practice Address - Country:US
Practice Address - Phone:212-533-2400
Practice Address - Fax:212-533-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty