Provider Demographics
NPI:1639591357
Name:COMPREHENSIVE MEDICAL THERAPEUTICS, P.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL THERAPEUTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-253-7737
Mailing Address - Street 1:1360 CLIFTON AVE # 275
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1343
Mailing Address - Country:US
Mailing Address - Phone:973-253-7737
Mailing Address - Fax:973-253-0213
Practice Address - Street 1:1360 CLIFTON AVE # 275
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1343
Practice Address - Country:US
Practice Address - Phone:973-253-7737
Practice Address - Fax:973-253-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA0775000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty