1396981882 NPI number — COMPREHENSIVE MULTI-SPECIALTY MEDICAL GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396981882 NPI number — COMPREHENSIVE MULTI-SPECIALTY MEDICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE MULTI-SPECIALTY MEDICAL GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396981882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632-0255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-342-0444
Provider Business Mailing Address Fax Number:
201-342-0709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 EAGLE ROCK AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ROSELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07068-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-342-0444
Provider Business Practice Location Address Fax Number:
201-342-0709
Provider Enumeration Date:
01/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARSH
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-320-5227

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  25MB08501200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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