Provider Demographics
NPI:1912753849
Name:COMPLETE DIAGNOSTIC & MEDICAL CENTER OF NJ PC
Entity type:Organization
Organization Name:COMPLETE DIAGNOSTIC & MEDICAL CENTER OF NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-898-1270
Mailing Address - Street 1:242 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2812
Mailing Address - Country:US
Mailing Address - Phone:973-783-1444
Mailing Address - Fax:973-509-8421
Practice Address - Street 1:718 UNION AVE STE 3
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1469
Practice Address - Country:US
Practice Address - Phone:732-898-1270
Practice Address - Fax:732-856-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty