Provider Demographics
NPI:1508904699
Name:DB INTERNAL & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:DB INTERNAL & SPORTS MEDICINE LLC
Other - Org Name:DBNJ SPORTS MEDICINE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHIMANT
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:BALAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-677-3733
Mailing Address - Street 1:PO BOX 6201
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-6201
Mailing Address - Country:US
Mailing Address - Phone:732-677-3733
Mailing Address - Fax:732-677-3734
Practice Address - Street 1:77 SCHANCK RD # 55
Practice Address - Street 2:SUITE B 11
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-677-3733
Practice Address - Fax:732-677-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600257676207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty