Provider Demographics
NPI:1336337930
Name:COMMUNITY AND CORPORATE CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY AND CORPORATE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:TRADER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-786-0235
Mailing Address - Street 1:8 LENAPE RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-4568
Mailing Address - Country:US
Mailing Address - Phone:973-786-0235
Mailing Address - Fax:973-786-0315
Practice Address - Street 1:8 LENAPE RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-4568
Practice Address - Country:US
Practice Address - Phone:973-786-0235
Practice Address - Fax:973-786-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB60024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F92733Medicare UPIN