Provider Demographics
NPI:1184673386
Name:DENVILLE ASSOCIATES OF INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:DENVILLE ASSOCIATES OF INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-627-2654
Mailing Address - Street 1:16 POCONO ROAD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-627-2650
Mailing Address - Fax:973-627-8383
Practice Address - Street 1:16 POCONO ROAD
Practice Address - Street 2:SUITE 317
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-627-2650
Practice Address - Fax:973-627-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2557908Medicaid
041164OtherAETNA
NJ0113509001OtherAMERIHEALTH
NJCB9983OtherRR MEDICARE
NJ0113509001OtherAMERIHEALTH
NJ2557908Medicaid