Provider Demographics
NPI:1689071722
Name:COMPREHENSIVE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-374-1080
Mailing Address - Street 1:1200 CLINTON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2070
Mailing Address - Country:US
Mailing Address - Phone:973-374-1080
Mailing Address - Fax:
Practice Address - Street 1:1200 CLINTON AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2070
Practice Address - Country:US
Practice Address - Phone:973-374-1080
Practice Address - Fax:973-373-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09682500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty