Provider Demographics
NPI:1144318981
Name:COMPREHENSIVE OBSTETRICS & GYNECOLOGY P C
Entity type:Organization
Organization Name:COMPREHENSIVE OBSTETRICS & GYNECOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-362-5900
Mailing Address - Street 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3553
Mailing Address - Country:US
Mailing Address - Phone:845-362-5900
Mailing Address - Fax:845-362-5348
Practice Address - Street 1:26 FIREMENS MEMORIAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3553
Practice Address - Country:US
Practice Address - Phone:845-362-5900
Practice Address - Fax:845-362-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W2L231Medicare PIN