1548593692 NPI number — COMPREHENSIVE PEDIATRIC CARE

Table of content: (NPI 1548593692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548593692 NPI number — COMPREHENSIVE PEDIATRIC CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PEDIATRIC CARE
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:
COMPREHENSIVE PEDIATRIC CARE
Provider Other Organization Name Type Code:
4
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:
1548593692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 HIGHWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLYN LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
07417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-445-6794
Provider Business Mailing Address Fax Number:
201-445-9515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 DAVIDSON AVE
Provider Second Line Business Practice Location Address:
DAVIDSON PEDIATRIC CENTER
Provider Business Practice Location Address City Name:
NEW JERSEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
07450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-933-4034
Provider Business Practice Location Address Fax Number:
718-933-0440
Provider Enumeration Date:
09/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GHAVAMI
Authorized Official First Name:
ZIA
Authorized Official Middle Name:
MAIOODIZIAADIN
Authorized Official Title or Position:
PEDIATRICIAN
Authorized Official Telephone Number:
201-445-6794

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  145846 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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