Provider Demographics
NPI:1790731271
Name:COMPREHENSIVE WOMENS HEALTHCARE
Entity Type:Organization
Organization Name:COMPREHENSIVE WOMENS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-591-9988
Mailing Address - Street 1:716 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1645
Mailing Address - Country:US
Mailing Address - Phone:973-591-9988
Mailing Address - Fax:973-591-1114
Practice Address - Street 1:220 HAMBURG TPKE
Practice Address - Street 2:21
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2110
Practice Address - Country:US
Practice Address - Phone:973-790-8090
Practice Address - Fax:973-790-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06580400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0002623Medicaid
NJ1992750715OtherAIMAN SHILAD
NJ1083636450OtherSHAZAH KHAWAJA
NJ13626093204OtherEDWARD KUGLER
NJ1487692299OtherKHASHAYAR VOSOUGH
NJ1508965344OtherRALPH CIFALDI
NJ1285684597OtherALINA LIBSTER
NJ1750329538OtherCHARLES HADDAD
NJ1639124506OtherMAHIPA PALLIMULLA
NJ1770518441OtherBRUCE BENNETT
NJ1750329538OtherCHARLES HADDAD
NJG63387Medicare UPIN