MEDICARE: DENVILLE MEDICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1386119758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVILLE MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	161 E. MAIN ST.
Second Line	:
City	:	DENVILLE
State	:	NJ
Zip	:	07834
Country	:	US
Telephone Number	:	973-627-7888
Fax Number	:	973-627-7040

Provider Business Practice Location Address
First Line	:	161 E. MAIN ST.
Second Line	:
City	:	DENVILLE
State	:	NJ
Zip	:	07834
Country	:	US
Telephone Number	:	973-627-7888
Fax Number	:	973-627-7040

Authorized Official
Title or Position	:	MEMBER
Name	:	DAVID BARRETT III
Credential	:
Telephone Number	:	973-627-7888

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	02/19/2026

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