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General NPI Number Information
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NPI Number | 1790731271
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE WOMENS HEALTHCARE
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 220 HAMBURG TPKE 21
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City | WAYNE
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State | NJ
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Zip | 07470-2110
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Country | US
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Telephone | 973-790-8090
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Fax | 973-790-3198
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Provider Business Mailing Address
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Address Line | 716 BROAD ST
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City | CLIFTON
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State | NJ
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Zip | 07013-1645
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Country | US
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Telephone | 973-591-9988
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Fax | 973-591-1114
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHASHAYAR VOSOUGH
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Credential | MD
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Telephone | 973-591-9988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA06580400
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License Number State | NJ
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