1790731271 NPI number — COMPREHENSIVE WOMENS HEALTHCARE

Table of content: (NPI 1790731271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790731271 NPI number — COMPREHENSIVE WOMENS HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE WOMENS HEALTHCARE
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:
1790731271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
716 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07013-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-591-9988
Provider Business Mailing Address Fax Number:
973-591-1114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
21
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-790-8090
Provider Business Practice Location Address Fax Number:
973-790-3198
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VOSOUGH
Authorized Official First Name:
KHASHAYAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-591-9988

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA06580400 , 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)

  • Identifier: 0002623 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992750715 . This is a "AIMAN SHILAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1083636450 . This is a "SHAZAH KHAWAJA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 13626093204 . This is a "EDWARD KUGLER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1487692299 . This is a "KHASHAYAR VOSOUGH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1508965344 . This is a "RALPH CIFALDI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1285684597 . This is a "ALINA LIBSTER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1750329538 . This is a "CHARLES HADDAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1639124506 . This is a "MAHIPA PALLIMULLA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770518441 . This is a "BRUCE BENNETT" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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