MEDICARE: COMPREHENSIVE MEDICAL AND IMAGING GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center	25MA08808900	NJ

General Provider Information

NPI Number	:	1437587037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL AND IMAGING GROUP PC

Provider Business Mailing Address
First Line	:	200 EAST 36 STREET, 11C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016
Country	:	US
Telephone Number	:	877-372-3266
Fax Number	:	877-372-3266

Provider Business Practice Location Address
First Line	:	725 RIVER RD STE 55
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1121
Country	:	US
Telephone Number	:	877-372-3266
Fax Number	:	877-372-3266

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DANIEL SHIFTEH
Credential	:	M.D
Telephone Number	:	917-804-6155

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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