=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912303090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE MEDICAL SERVICES OF NEW JERSEY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2014
-----------------------------------------------------
Last Update Date | 11/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 822 N WOOD AVE 3RD FLOOR, SUITE 2
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-925-9100
-----------------------------------------------------
Fax | 908-546-1161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 822 N WOOD AVE 3RD FLOOR, SUITE 2
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-925-9100
-----------------------------------------------------
Fax | 908-546-1161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. APOSTOLOS VOUDOURIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-266-4771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 25MA07313600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------