MEDICARE: COMPREHENSIVE CARDIAC CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	25MA07871300	NJ

General Provider Information

NPI Number	:	1033364054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CARDIAC CARE, LLC

Provider Business Mailing Address
First Line	:	201 LYONS AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07112-2027
Country	:	US
Telephone Number	:	973-926-8134
Fax Number	:	973-705-3096

Provider Business Practice Location Address
First Line	:	208 HUTTON ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3704
Country	:	US
Telephone Number	:	917-703-7660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DIVYA BHATIA
Credential	:	MD
Telephone Number	:	917-703-7660

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	12/15/2008

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