Healthcare Provider Details

I. General information

NPI: 1790469856
Provider Name (Legal Business Name): COMPLETE DIAGNOSTIC AND MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 STATE ST
HACKENSACK NJ
07601-5448
US

IV. Provider business mailing address

126 STATE ST
HACKENSACK NJ
07601-5448
US

V. Phone/Fax

Practice location:
  • Phone: 877-890-9906
  • Fax:
Mailing address:
  • Phone: 877-890-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ZAITSEV
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 877-890-9906