# LAKEVILLE COMPREHENSIVE MEDICAL INJURY CARE P.L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104199942
- **Authorized official:** MR. JAHANSHAH ROOFEH M.D (PRESIDENT)
- **Authorized official phone:** (516) 358-7557

## Contact information

- **Practice address:** 2035 LAKEVILLE RD STE 300, NEW HYDE PARK, NY 11040-1661
- **Practice address phone:** (516) 492-3307
- **Practice address fax:** (516) 492-3299
- **Mailing address:** 2035 LAKEVILLE RD STE 300, NEW HYDE PARK, NY 11040-1661
- **Mailing address phone:** (516) 492-3307
- **Mailing address fax:** (516) 492-3299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 235820 | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 248529-1 | NY | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | A241419 | NY | — |

## Other

- **Enumeration date:** 02/09/2012
- **Last updated:** 02/09/2012