Healthcare Provider Details

I. General information

NPI: 1992296784
Provider Name (Legal Business Name): COMPREHENSIVE CARDIOVASCULAR SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 DURHAM AVE STE 1A
SOUTH PLAINFIELD NJ
07080-2555
US

IV. Provider business mailing address

PO BOX 103
HILLSDALE NJ
07642-0103
US

V. Phone/Fax

Practice location:
  • Phone: 201-522-3205
  • Fax:
Mailing address:
  • Phone: 201-522-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08417900
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN SHAO
Title or Position: MD
Credential: MD
Phone: 201-522-3205