Provider Demographics
NPI:1558657692
Name:COMPREHENSIVE LUNG CARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE LUNG CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-379-9033
Mailing Address - Street 1:2468 US HIGHWAY 206
Mailing Address - Street 2:PO BOX 847
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-4017
Mailing Address - Country:US
Mailing Address - Phone:732-820-0088
Mailing Address - Fax:732-837-3070
Practice Address - Street 1:1440 HOW LN
Practice Address - Street 2:STE 2D
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4600
Practice Address - Country:US
Practice Address - Phone:732-820-0088
Practice Address - Fax:732-837-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RP1001X
NJ25MA08083800261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty