Provider Demographics
NPI:1104528587
Name:CT COMPREHENSIVE MEDICAL PLLC
Entity type:Organization
Organization Name:CT COMPREHENSIVE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHETTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-464-6289
Mailing Address - Street 1:71 OXFORD RD UNIT L
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1900
Mailing Address - Country:US
Mailing Address - Phone:203-828-0013
Mailing Address - Fax:
Practice Address - Street 1:71 OXFORD RD UNIT L
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1900
Practice Address - Country:US
Practice Address - Phone:203-828-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CT COMPREHENSIVE MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty