Provider Demographics
NPI:1982753083
Name:CENTER FOR COMPREHENSIVE CARE LLC
Entity Type:Organization
Organization Name:CENTER FOR COMPREHENSIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:203-225-0504
Mailing Address - Street 1:31 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5323
Mailing Address - Country:US
Mailing Address - Phone:203-225-0504
Mailing Address - Fax:203-792-1675
Practice Address - Street 1:31 STAPLES ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5323
Practice Address - Country:US
Practice Address - Phone:203-225-0504
Practice Address - Fax:203-792-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038204207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004253770Medicaid
CT004253770Medicaid