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General NPI Number Information
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NPI Number | 1164233409
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE COMMUNITY CARE
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 200 FREEWAY DR E STE 302
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City | EAST ORANGE
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State | NJ
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Zip | 07018-3837
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Country | US
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Telephone | 845-738-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FREEWAY DR E STE 302
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City | EAST ORANGE
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State | NJ
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Zip | 07018-3837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLIMY JACOBS
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Credential |
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Telephone | 845-662-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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