Provider Demographics
NPI:1881865228
Name:COMPREHENSIVE FAMILY MEDICINE
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:CAVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-222-7777
Mailing Address - Street 1:27 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5605
Mailing Address - Country:US
Mailing Address - Phone:908-222-7777
Mailing Address - Fax:
Practice Address - Street 1:27 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5605
Practice Address - Country:US
Practice Address - Phone:908-222-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081420Medicare PIN