Healthcare Provider Details

I. General information

NPI: 1942379243
Provider Name (Legal Business Name): MS COMPREHENSIVE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

718 TEANECK RD
TEANECK NJ
07666-4245
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-3000
  • Fax: 201-833-4486
Mailing address:
  • Phone: 201-833-3000
  • Fax: 201-833-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number70270
License Number StateNJ

VIII. Authorized Official

Name: RYAN KENNEDY
Title or Position: VP OF FINANCE
Credential:
Phone: 801-833-7016