1740328608 NPI number — MS COMPREHENSIVE CARE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740328608 NPI number — MS COMPREHENSIVE CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MS COMPREHENSIVE CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740328608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 UNIVERSITY PLZ STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-833-3599
Provider Business Mailing Address Fax Number:
201-227-6207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 TEANECK RD
Provider Second Line Business Practice Location Address:
HOLY NAME HOSPITAL
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-837-0727
Provider Business Practice Location Address Fax Number:
201-837-8504
Provider Enumeration Date:
02/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BENIQUEZ PACHECO
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
201-833-3599

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)