Provider Demographics
NPI:1235478520
Name:PRONERVE PHYSICIANS NJ LLC
Entity Type:Organization
Organization Name:PRONERVE PHYSICIANS NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PILLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-536-2388
Mailing Address - Street 1:7600 E ORCHARD RD
Mailing Address - Street 2:200N
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2520
Mailing Address - Country:US
Mailing Address - Phone:303-339-1499
Mailing Address - Fax:303-962-4819
Practice Address - Street 1:7600 E ORCHARD RD
Practice Address - Street 2:200N
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2520
Practice Address - Country:US
Practice Address - Phone:303-339-1499
Practice Address - Fax:303-962-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08855500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty