Provider Demographics
NPI:1558453498
Name:DENEVE, ALBERT ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ANDRE
Last Name:DENEVE
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 1:143 E RIDGEWOOD AVE UNIT 539
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-7026
Mailing Address - Country:US
Mailing Address - Phone:201-251-9030
Mailing Address - Fax:201-251-9032
Practice Address - Street 1:143 E RIDGEWOOD AVE UNIT 539
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07451-7026
Practice Address - Country:US
Practice Address - Phone:201-251-9030
Practice Address - Fax:201-251-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04896500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6068006Medicaid
NJ707772OtherMEDICARE PTAN
NJ6068006Medicaid