Provider Demographics
NPI:1588366942
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 1:115 TECHNOLOGY DR UNIT B306
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6338
Mailing Address - Country:US
Mailing Address - Phone:203-318-6606
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT B306
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6338
Practice Address - Country:US
Practice Address - Phone:203-318-6606
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