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General NPI Number Information
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NPI Number | 1033364054
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CARDIAC CARE, LLC
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 208 HUTTON ST
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City | JERSEY CITY
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State | NJ
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Zip | 07307-3704
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Country | US
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Telephone | 917-703-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 201 LYONS AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-8134
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Fax | 973-705-3096
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIVYA BHATIA
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Credential | MD
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Telephone | 917-703-7660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA07871300
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License Number State | NJ
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