Provider Demographics
NPI:1548593692
Name:COMPREHENSIVE PEDIATRIC CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE PEDIATRIC CARE
Other - Org Name:COMPREHENSIVE PEDIATRIC CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:MAIOODIZIAADIN
Authorized Official - Last Name:GHAVAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-445-6794
Mailing Address - Street 1:718 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLYN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:201-445-6794
Mailing Address - Fax:201-445-9515
Practice Address - Street 1:2400 DAVIDSON AVE
Practice Address - Street 2:DAVIDSON PEDIATRIC CENTER
Practice Address - City:NEW JERSEY
Practice Address - State:NY
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:718-933-4034
Practice Address - Fax:718-933-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty