Provider Demographics
NPI:1700096427
Name:COMPREHENSIVE MEDICAL CARE PC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-567-1140
Mailing Address - Street 1:401 S VAN BRUNT ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-567-1140
Mailing Address - Fax:201-567-1998
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-567-1140
Practice Address - Fax:201-567-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004611Medicare PIN
NJ535269Medicare PIN