Provider Demographics
NPI:1295936383
Name:DENVILLE FAMILY PRACTICE, PC
Entity type:Organization
Organization Name:DENVILLE FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-625-3515
Mailing Address - Street 1:16 POCONO RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-625-3515
Mailing Address - Fax:
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 307
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-625-3515
Practice Address - Fax:973-627-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03569500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty