Provider Demographics
NPI:1689826109
Name:HOUSE PHYSICIANS OF CHILTON, LLC
Entity Type:Organization
Organization Name:HOUSE PHYSICIANS OF CHILTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENNARO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-650-1855
Mailing Address - Street 1:54 NICOLE DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-9531
Mailing Address - Country:US
Mailing Address - Phone:201-650-1855
Mailing Address - Fax:973-366-4315
Practice Address - Street 1:97 W PARKWAY
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1647
Practice Address - Country:US
Practice Address - Phone:973-831-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty