Provider Demographics
NPI:1629165048
Name:COMPREHENSIVE HEALTHCARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LIZABETH
Authorized Official - Last Name:AQUAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-679-7705
Mailing Address - Street 1:385 MAIN ST S
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4240
Mailing Address - Country:US
Mailing Address - Phone:203-262-4600
Mailing Address - Fax:
Practice Address - Street 1:385 MAIN ST S
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4240
Practice Address - Country:US
Practice Address - Phone:203-262-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO3450OtherMEDICARE GROUP NUMBER