Healthcare Provider Details

I. General information

NPI: 1437587037
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL AND IMAGING GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD STE 55
EDGEWATER NJ
07020-1121
US

IV. Provider business mailing address

200 EAST 36 STREET, 11C
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 877-372-3266
  • Fax: 877-372-3266
Mailing address:
  • Phone: 877-372-3266
  • Fax: 877-372-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number25MA08808900
License Number StateNJ

VIII. Authorized Official

Name: DANIEL SHIFTEH
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 917-804-6155