Organization
AMERICAN COMPREHENSIVE HEALTHCARE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELVIN K JACK M.D. (PRESIDENT)
(718) 688-8088
Entity
Organization
Contact information
Practice address
5205-7 CHURCH AVENUE, BROOKLYN, NY 11203-3513
(718) 688-8088
(718) 688-8018
Mailing address
5205-7 CHURCH AVENUE, BROOKLYN, NY 11203-0386
(718) 688-8088
(718) 688-8081
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
002201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002201
LICENSE
NY
05
—
002778018
—
NY
Enumeration date
10/30/2014
Last updated
10/30/2014
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