Organization
UNITED COMPREHENSIVE CARE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH GAUL (CEO)
(631) 473-7100
Entity
Organization
Contact information
Practice address
170 OLD COUNTRY RD, RIVERHEAD, NY 11901-2198
(631) 473-7100
Mailing address
170 OLD COUNTRY RD, RIVERHEAD, NY 11901-2198
(631) 473-7100
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515203R
NYS DOH OPERATING CERTIFICATE
NY
Enumeration date
07/02/2012
Last updated
05/20/2015
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