Organization
AMERICAN COMPREHENSIVE HEALTHCARE MEDICAL GROUP. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELVIN K JACK M.D. (MEDICAL DOCTOR)
(718) 688-8000
Entity
Organization
Contact information
Practice address
5205 CHURCH AVE, BROOKLYN, NY 11203-3513
(718) 688-8000
(718) 688-8081
Mailing address
5205 CHURCH AVE, BROOKLYN, NY 11203-3513
(718) 688-8000
(718) 688-8081
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
002201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03109400
—
NY
Enumeration date
03/22/2013
Last updated
03/22/2013
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