Healthcare Provider Details

I. General information

NPI: 1982194551
Provider Name (Legal Business Name): SAMANTHA LYNN DENOVILLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ROUTE 31 STE 1200
FLEMINGTON NJ
08822-5755
US

IV. Provider business mailing address

1 KENSINGTON CT
JACKSON NJ
08527-1292
US

V. Phone/Fax

Practice location:
  • Phone: 908-237-4106
  • Fax: 908-968-3181
Mailing address:
  • Phone: 908-692-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: