Healthcare Provider Details

I. General information

NPI: 1255602835
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 PASSAIC ST
GARFIELD NJ
07026-1319
US

IV. Provider business mailing address

297 PASSAIC ST
GARFIELD NJ
07026-1319
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-2293
  • Fax: 973-777-9117
Mailing address:
  • Phone: 973-777-2293
  • Fax: 973-777-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB069001
License Number StateNJ

VIII. Authorized Official

Name: DR. DONNA MARIE KOCH
Title or Position: PHYSICIAN
Credential: DO
Phone: 973-777-2293