Provider Demographics
NPI:1568586824
Name:DAVID V. NENNA, MD, PA
Entity Type:Organization
Organization Name:DAVID V. NENNA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-730-7636
Mailing Address - Street 1:1465 STATE ROUTE 31 S
Mailing Address - Street 2:THE CONCOUSE AT BEAVER BROOK
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-3129
Mailing Address - Country:US
Mailing Address - Phone:908-730-7636
Mailing Address - Fax:908-735-4651
Practice Address - Street 1:1465 STATE ROUTE 31 S
Practice Address - Street 2:THE CONCOUSE AT BEAVER BROOK
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3129
Practice Address - Country:US
Practice Address - Phone:908-730-7636
Practice Address - Fax:908-735-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03538500207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNE110493Medicare ID - Type Unspecified
NJC57865Medicare UPIN