Provider Demographics
NPI:1114959939
Name:TAVANI, DENIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:A
Last Name:TAVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2055
Mailing Address - Country:US
Mailing Address - Phone:856-935-0567
Mailing Address - Fax:856-935-7576
Practice Address - Street 1:309 ROUTE 45
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2055
Practice Address - Country:US
Practice Address - Phone:856-935-0567
Practice Address - Fax:856-935-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025125Medicare ID - Type Unspecified
NJC52606Medicare UPIN