1568889277 NPI number — COMSTI MEDICAL, LLC

Table of content: (NPI 1568889277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568889277 NPI number — COMSTI MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMSTI MEDICAL, LLC
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:
1568889277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 NEPTUNE BLVD
Provider Second Line Business Mailing Address:
BUILDING B, SUITE 2
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-774-0436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 NEPTUNE BLVD
Provider Second Line Business Practice Location Address:
BUILDING B, SUITE 2
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-774-0436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COMSTI
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
732-890-4895

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA06813500 , 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: 7823100 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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