Provider Demographics
NPI:1083936561
Name:COMPREHENSIVE INFECTIOUS DISEASE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE INFECTIOUS DISEASE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHOLAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-997-7588
Mailing Address - Street 1:1018 BROAD ST
Mailing Address - Street 2:SUITE 8, SECOND FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2884
Mailing Address - Country:US
Mailing Address - Phone:973-997-7588
Mailing Address - Fax:
Practice Address - Street 1:1018 BROAD ST
Practice Address - Street 2:SUITE 8, SECOND FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2884
Practice Address - Country:US
Practice Address - Phone:973-997-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07969700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02913642Medicaid